NPIMap

Organization Active NPI

Avera Queen of Peace

Doing business as Avera Hoek Medical Clinic

  • Physician Assistant
  • De Smet, SD
National Provider Identifier
1053557967
Registry record updated Mar 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0232SD Issued in SD
Legal business name
AVERA QUEEN OF PEACE
Doing business as
Avera Hoek Medical Clinic
Practice address
115 Second St SE
De Smet, SD 57231-0463
Phone
(605) 854-3834
Fax
(605) 854-3878
NPI assigned
Dec 23, 2008
Last updated
Mar 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2010

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

Authorized official

Name
Mr. Patrick J. Clark
Title
Senior Vice President and Cfo
Phone
(605) 995-2251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0232SD SD Primary

Addresses

Primary practice location

115 Second St SE
De Smet, SD 57231-0463

Mailing address

525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2000

Other names 1

  • Avera Hoek Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000301 SD Part B Supplier - Clinic/Group Practice 9335050806 Receives reassigned benefits from 252 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mitchell, SD; Parkston, SD; Pierre, SD; Platte, SD; Sioux Falls, SD; Wagner, SD; Wessington Springs, SD; Yankton, SD…

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267401600000",
    "number": "1053557967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000",
            "fax_number": "605-995-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 SECOND ST SE",
            "city": "DE SMET",
            "state": "SD",
            "postal_code": "572310463",
            "telephone_number": "605-854-3834",
            "fax_number": "605-854-3878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-23",
        "last_updated": "2010-03-01",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "605-995-2251",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0232SD",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Hoek Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Smet, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.