NPIMap

Organization Active NPI

Avera Marshall

Doing business as Avera Medical Group Optometry Windom

  • Optometrist
  • Windom, MN
National Provider Identifier
1083925366
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AVERA MARSHALL
Doing business as
Avera Medical Group Optometry Windom
Practice address
1006 4TH Ave
Windom, MN 56101-1440
Phone
(507) 831-2429
NPI assigned
Jul 1, 2010
Last updated
Dec 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X MN Primary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X MN
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1006 4TH Ave
Windom, MN 56101-1440

Mailing address

1006 4TH Ave
Windom, MN 56101-1440
Phone (507) 831-2429

Other names 1

  • Avera Medical Group Optometry Windom Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000219 MN Part B Supplier - Clinic/Group Practice 5799695227 Receives reassigned benefits from 278 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tracy, MN; Springfield, MN; Dawson, MN; Redwood Falls, MN; Minneota, MN; Marshall, MN; Eden Prairie, MN; Canby, MN…

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 14

Organizations listed as members of this organization in the National Provider Directory.

View all 14

Locations

300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1083925366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 4TH AVE",
            "city": "WINDOM",
            "state": "MN",
            "postal_code": "561011440",
            "telephone_number": "507-831-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 4TH AVE",
            "city": "WINDOM",
            "state": "MN",
            "postal_code": "561011440",
            "telephone_number": "507-831-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MARSHALL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "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": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Optometry Windom",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Medical Group Optometry Windom",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windom, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; 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.