MACON CITY DRUG STORE, INC. — NPI 1912104415 (Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies in MACON, MS)

CMS-1500 Box 24J / 33a • NPI

1912104415

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

332B00000X (CMS 54)

Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies

Box 32 Service Location & ZIP+4

3281 JEFFERSON ST, MACON, MS, 39341-2279

✓ 9-Digit EDI 837 ZIP+4 (39341-2279)

Practice Phone & Referral Fax

(662) 726-5143

Fax: (662) 726-5183

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1912104415 (MACON CITY DRUG STORE, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1912104415)

Medicare Beneficiaries

Total Billed Services

104

Distinct CPT/HCPCS Codes

Medicare Allowed Total

$6,713.70

Actual Top Billed CPT / HCPCS Procedures (CMS Part B)

CPT / HCPCS	Clinical Procedure Description	Services
`90662`	Influenza vaccine split virus, preservative free	42
`G0008`	Administration of influenza virus vaccine	46

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1912104415` (NPI-2 Organization / Facility)
Provider / Legal Name	MACON CITY DRUG STORE, INC.
Plain-English Specialty	Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies NUCC Code: `332B00000X` (Durable Medical Equipment & Medical Supplies)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	3281 JEFFERSON ST, MACON, MS, 39341-2279
Practice Telephone / Fax	Tel: (662) 726-5143 \| Fax: (662) 726-5183
Administrative Mailing Address	PO BOX 424, MACON, MS, 39341-0424
Enumeration & Last Sync	Enumerated: 2007-06-28 \| CMS Record Updated: 2024-01-26
Authorized Official	BECKY WATT (DME PROVIDER)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3281 JEFFERSON ST, MACON, MS, 39341-2279

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Plain-English Taxonomy & CMS Crosswalk (332B00000X)

What Does Taxonomy Code 332B00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 332B00000X translates to:
"Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 54 (Other Medical Supply Company) • CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code 87[3] (All Other Suppliers) • CMS Code A2[9] (Intermediate Care Nursing Facility) • CMS Code A6 (Medical Supply Company with Respiratory Therapist) • CMS Code A7 (Department Store) • CMS Code A8 (Grocery Store) • CMS Code B3 (Medical supply company with pedorthic personnel)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Durable Medical Equipment & Medical Supplies for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MACON CITY DRUG STORE, INC.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336L0003X` — Pharmacy, Long Term Care Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary
`332B00000X` — Durable Medical Equipment & Medical Supplies Plain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies	State: MS \| License: `0012501.1` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MACON CITY DRUG STORE, INC. (NPI #1912104415)