Active NPI
Avera Tyler
Doing business as Avera Lake Benton Clinic
- Rural Health Clinic/Center
- Lake Benton, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- AVERA TYLER
- Doing business as
- Avera Lake Benton Clinic
Avera Medical Group Lake Benton - Practice address
- 109 E Benton St
Lake Benton, MN 56149-1309 - Phone
- (507) 368-4323
- Fax
- (507) 368-4546
- NPI assigned
- May 19, 2006
- Last updated
- Jun 12, 2026
- Organization subpart
- Yes
- Parent organization
- AVERA MEDICAL GROUP TYLER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Debbie Streier
- Title
- Ceo
- Phone
- (507) 537-9160
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
109 E Benton St
Lake Benton, MN 56149-1309
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (507) 368-4323
Other names 2
- Avera Lake Benton Clinic
- Avera Medical Group Lake Benton
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040320000679 | MN | Part B Supplier - Clinic/Group Practice | 1557252533 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lake Benton, MN; Tyler, MN |
| O20161129000531 | MN | Part A Provider - Rural Health Clinic | 9638088537 | Practice locations: Lake Benton, MN |
| O20170630001868 | MN | Part B Supplier - Clinic/Group Practice | 9638088537 |
Receives reassigned benefits from 58 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tyler, MN; Lake Benton, MN; Ivanhoe, MN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1003869892. Details of each certification follow.
Rural health clinic certification: CCN 243470
- Legal name
- AVERA TYLER
- Doing business as
- AVERA MEDICAL GROUP TYLER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 11, 2014
- Last certification
- Jun 11, 2014
- Ownership / control type
- 2B
- Most recent change of ownership
- Mar 1, 2016 (1 total)
- Organization structure
- Corporation
- Incorporated
- Nov 30, 1961 in MN
- Enrollment address
- 109 E Benton St
Lake Benton, MN 56149-1309 - Related CCNs
- 241348
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba Avera Tyler Hospital
- Critical Access Hospital
- Tyler, MN
- NPI 1801840517
Parent provider
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Avera Medical Group Tyler
- Rural Health Clinic/Center
- Tyler, MN
- NPI 1649223439
9638088537
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Avera Medical Group Ivanhoe
- Rural Health Clinic/Center
- Ivanhoe, MN
- NPI 1063949089
O20170630001868
-
dba Avera Medical Group Tyler
- Rural Health Clinic/Center
- Tyler, MN
- NPI 1649223439
O20040320000679, O20170630001868
-
dba Avera Tyler Hospital
- Critical Access Hospital
- Tyler, MN
- NPI 1801840517
O20170630001868
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0934038 | Avera Medical Group Lake Benton | Certificate of waiver | Sep 28, 2027 |
National Provider Directory
National Provider Directory- Part of
- Tyler Healthcare Center Dba Tyler Healthcare Pharmacy
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Avera Medical Group Optometry Windom
- Optometrist
- Windom, MN
- NPI 1083925366
Member Of
Locations
1210 E College Dr
Marshall, MN 56258
Phone (507) 247-5921
2042 Juniper Ave
Slayton, MN 56172
Phone (507) 836-1227
Ownership & related parties
All disclosed owners & managing parties 21
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| James Francis Dover | Corporate Officer | Oct 23, 2023 | |
| Joyce H Strootman | Corporate Director | Jul 1, 2015 | |
| Quentin J Fixen | Corporate Director | Jul 1, 2018 | |
| Jill Vroman | Corporate Director | Jul 1, 2023 | |
| Debra Ann Streier | Corporate Officer | Feb 1, 2021 | |
| George L Jorgenson | Corporate Director | Mar 1, 2016 | |
| Tim O'Leary | Corporate Director | Jul 1, 2023 | |
| Jodelle a Zimmerman | Corporate Director | Jul 1, 2018 | |
| Sharon Hennen | Corporate Director | Jul 1, 2023 | |
| Gregory W Goepferich | Corporate Director | Jul 1, 2020 | |
| Amanda Sieling | Corporate Director | Jul 1, 2018 | |
| Lavonne Annette Koenen | Corporate Director | Jul 1, 2020 | |
| Thomas J Kooiman | Corporate Officer | May 29, 2022 | |
| Operational/Managerial Control | May 29, 2022 | ||
| Avera Marshall | 5% Or Greater Direct Ownership Interest | Mar 1, 2016 | 100% |
| Operational/Managerial Control | Mar 1, 2016 | ||
| Laurie J Johansen | Corporate Director | Mar 1, 2016 | |
| Christy Ann Coudron | Corporate Officer | Sep 1, 2020 | |
| Stephen Menzies Crim | Corporate Director | Jul 1, 2019 | |
| Mark M Vortherms | Corporate Officer | Sep 29, 2020 | |
| Julie Lautt | Corporate Officer | Mar 1, 2020 | |
| Curtis Ronald Louwagie | Corporate Director | Jul 1, 2018 | |
| Avera Health | 5% Or Greater Indirect Ownership Interest | Mar 1, 2016 | 100% |
Owners & managing parties with NPI records 17
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Avera@Home Southwest Minnesota
- Home Health Agency
- Marshall, MN
- NPI 1033535547
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Dialysis Marshall
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Marshall, MN
- NPI 1154856839
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Morningside Heights Care Center
- Skilled Nursing Facility
- Marshall, MN
- NPI 1255329033
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Eye Care Dawson
- Optometrist
- Dawson, MN
- NPI 1396513370
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Eye Care Tracy
- Optometrist
- Tracy, MN
- NPI 1487958062
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Marshall Regional Medical Center
- Critical Access Hospital
- Marshall, MN
- NPI 1568401016
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Eye Care Marshall
- Durable Medical Equipment & Medical Supplies
- Marshall, MN
- NPI 1669622031
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Marshall Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Marshall, MN
- NPI 1700070430
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Marshall Regional Medical Center
- Psychiatric Hospital Unit
- Marshall, MN
- NPI 1750508412
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Eye Care Springfield
- Ophthalmology Physician
- Springfield, MN
- NPI 1922316041
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera Eye Care Canby
- Optometrist
- Canby, MN
- NPI 1952179939
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Avera@Home Southwest Minnesota
- Community Based Hospice Care Agency
- Marshall, MN
- NPI 1952727463
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
Facilities with the same owner 91
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Avera Granite Falls Health Center Swingbed
- Medicare Defined Swing Bed Hospital Unit
- Granite Falls, MN
- NPI 1578106498
Avera Health, Avera Marshall
-
dba Avera Granite Falls Care Center
- Skilled Nursing Facility
- Granite Falls, MN
- NPI 1679116503
Avera Marshall
-
dba Avera Granite Falls Health Center
- Critical Access Hospital
- Granite Falls, MN
- NPI 1700429610
Avera Health, Avera Marshall
-
dba Avera@Home Southwest Minnesota
- Home Health Agency
- Marshall, MN
- NPI 1033535547
Avera Health
-
dba Avera Morningside Heights Care Center
- Skilled Nursing Facility
- Marshall, MN
- NPI 1255329033
Avera Health
-
dba Avera Marshall Regional Medical Center
- Critical Access Hospital
- Marshall, MN
- NPI 1568401016
Avera Health
-
dba Avera Marshall Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Marshall, MN
- NPI 1700070430
Avera Health
-
dba Avera Marshall Regional Medical Center
- Psychiatric Hospital Unit
- Marshall, MN
- NPI 1750508412
Avera Health
-
dba Avera@Home Southwest Minnesota
- Community Based Hospice Care Agency
- Marshall, MN
- NPI 1952727463
Avera Health
-
- Medicare Defined Swing Bed Hospital Unit
- Tyler, MN
- NPI 1326102237
Avera Health, Avera Marshall
-
dba Avera Medical Group Tyler
- Rural Health Clinic/Center
- Tyler, MN
- NPI 1649223439
Avera Health, Avera Marshall
-
dba Avera Tyler Hospital
- Critical Access Hospital
- Tyler, MN
- NPI 1801840517
Avera Health, Avera Marshall
Practitioners & affiliated clinicians
Practitioners 20
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Registered Dietitian
- Marshall, MN
- NPI 1174066393
-
- Physician Assistant
- Marshall, MN
- NPI 1841604063
-
- Family Nurse Practitioner
- Ivanhoe, MN
- NPI 1629414578
-
- Family Nurse Practitioner
- Tyler, MN
- NPI 1164498804
-
- General Practice Physician
- Tyler, MN
- NPI 1235186230
-
- Physician Assistant
- Marshall, MN
- NPI 1013647080
-
- Certified Registered Nurse Anesthetist
- Marshall, MN
- NPI 1932600970
-
- Nurse Practitioner
- Canby, MN
- NPI 1063674554
-
- Foot & Ankle Surgery Podiatrist
- Marshall, MN
- NPI 1912344151
-
- Family Nurse Practitioner
- Marshall, MN
- NPI 1710207063
-
- Family Nurse Practitioner
- Marshall, MN
- NPI 1619231834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1781222400000",
"number": "1003869892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 86370",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571186370",
"telephone_number": "507-368-4323",
"fax_number": "507-368-4546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 E BENTON ST",
"city": "LAKE BENTON",
"state": "MN",
"postal_code": "561491309",
"telephone_number": "507-368-4323",
"fax_number": "507-368-4546"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVERA TYLER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AVERA MEDICAL GROUP TYLER",
"enumeration_date": "2006-05-19",
"last_updated": "2026-06-12",
"certification_date": "2026-06-12",
"status": "A",
"authorized_official_last_name": "STREIER",
"authorized_official_first_name": "DEBBIE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "507-537-9160"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Avera Lake Benton Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Avera Medical Group Lake Benton",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lake Benton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.