Avera McKennan

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

10563 Issued in SD

Legal business name

AVERA MCKENNAN

Doing business as

Avera Dialysis Mitchell

Practice address

1900 Grassland Dr
Ste 102
Mitchell, SD 57301-6205

Phone

(605) 995-6730

NPI assigned

Nov 3, 2014

Last updated

Sep 13, 2023By 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

Ronald Joseph Place, MD

Title

President/Ceo

Phone

(605) 322-7903

Specialties & licenses 1

Addresses

Other names 1

• Avera Dialysis Mitchell Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Listed as

Avera Dialysis - MitchellCCN 433511

Overall star rating

4.0 of 5

Ownership

Non-profit

Certified

Feb 26, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

12

Tax ID family

Amg Radiology105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

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

• Avera McKennan

  dba Avera Medical Group Addiction Medicine

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Sioux Falls, SD
  • NPI 1013668698
  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

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Ismail Omran

  • Nephrology Physician
  • Sioux Falls, SD
  • NPI 1023539590

  Dialysis facility

  Care Compare affiliation Name & address match
• Junaid Ali Syed, MD

  • Nephrology Physician
  • Sioux Falls, SD
  • NPI 1730357161

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1414972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1023413093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045",
            "address_2": "ATTN: P.F.S. PROV ENRLLMT",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 GRASSLAND DR",
            "address_2": "STE 102",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573016205",
            "telephone_number": "605-995-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-03",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "PLACE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SD",
            "license": "10563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Dialysis Mitchell",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Dialysis Mitchell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Avera at Home (Avera@Home)
• Avera at Home (Avera@Home)
• Avera at Home (Avera@Home)
• Avera Home Medical Equipment, LLC
• Avera Home Medical Equipment, LLC
• Avera Queen of Peace (Avera Brady DME Supplier)
• Avera Queen of Peace (Avera Medical Group Occupational Medicine)
• Avera Queen of Peace (Avera Medical Group Radiology Mitchell)
• Avera Queen of Peace (Avera Family Medicine Mitchell/AveraNOW)
• Avera Queen of Peace (Avera Medical Group Surgery)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mitchell, SD
• Providers in Mitchell, SD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.

Verify at the official NPI Registry.