Avera McKennan

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

Legal business name

AVERA MCKENNAN

Doing business as

Avera Medical Group Addiction Medicine

Practice address

4400 W 69TH St Ste 3100
Sioux Falls, SD 57108-8170

Phone

(605) 504-3522

Fax

(605) 322-4345

NPI assigned

Jan 14, 2022

Last updated

Jan 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David William Flicek

Title

President/Ceo

Phone

(605) 322-7915

Specialties & licenses 2

Addresses

Other names 1

• Avera Medical Group Addiction Medicine Doing business as

Tax ID family

Presentation Health Sys105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Avera McKennan

  dba Avera Dialysis Mitchell

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mitchell, SD
  • NPI 1023413093
  NPD tax ID
• Avera McKennan

  dba AveraNow

  • Physician Assistant
  • Sioux Falls, SD
  • NPI 1023480951
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group McGreevy 69th & Minnesota Pediatrics

  • Pediatrics Physician
  • Sioux Falls, SD
  • NPI 1033405436
  NPD tax ID
• Avera McKennan

  dba Avera Prince of Peace Assisted Living

  • Assisted Living Facility
  • Sioux Falls, SD
  • NPI 1053556068
  NPD tax ID
• Avera McKennan

  dba Avera Interventional Radiology

  • Diagnostic Radiology Physician
  • Sioux Falls, SD
  • NPI 1053680678
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group Brookings

  • Clinical Medical Laboratory
  • Brookings, SD
  • NPI 1063782373
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group Health Care Clinic Sioux Falls

  • Internal Medicine Physician
  • Sioux Falls, SD
  • NPI 1083894067
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group Milbank

  • Family Medicine Physician
  • Milbank, SD
  • NPI 1114594868
  NPD tax ID
• Avera McKennan

  dba Avera Children's

  • Pediatric Hematology & Oncology Physician
  • Sioux Falls, SD
  • NPI 1144488537
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group 69th and Cliff

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1144635863
  NPD tax ID
• Avera McKennan

  dba Avera McKennan Hospital and University Health Center - Diabetic Ed

  • General Acute Care Hospital
  • Sioux Falls, SD
  • NPI 1154531630
  NPD tax ID
• Avera McKennan

  dba Avera Addiction Care Center

  • Substance Abuse Rehabilitation Facility
  • Sioux Falls, SD
  • NPI 1154979805
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1013668698",
    "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": "605-322-6408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W 69TH ST STE 3100",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088170",
            "telephone_number": "605-504-3522",
            "fax_number": "605-322-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-14",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "FLICEK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7915"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Addiction Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Avera McKennan
• Avera McKennan (Avera Medical Group University Psychiatry Associates Sioux Falls)
• Avera McKennan (AveraNow)
• Avera McKennan (Avera Medical Group Oncology and Hematology Sioux Falls)
• Avera McKennan (Avera Medical Group McGreevy 69th & Minnesota Pediatrics)

• Addiction Medicine (Psychiatry & Neurology) Physician in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.