Avera McKennan

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

4319 Issued in SD

Legal business name

AVERA MCKENNAN

Practice address

1100 E 21St St
Ste 220
Sioux Falls, SD 57105-1020

Phone

(605) 322-4825

Fax

(605) 322-4826

NPI assigned

Aug 20, 2007

Organization subpart

No

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

Authorized official

Name

Julie N Norton

Title

Senior VP of Finance

Phone

(605) 322-6375

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Avera Neurosurgery - Mark W. Fox, M.D., FACS Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331510400000",
    "number": "1093908501",
    "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": "605-322-7510",
            "fax_number": "605-322-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E 21ST ST",
            "address_2": "STE 220",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051020",
            "telephone_number": "605-322-4825",
            "fax_number": "605-322-4826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2012-03-12",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SENIOR VP OF FINANCE",
        "authorized_official_telephone_number": "605-322-6375"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "SD",
            "license": "4319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025562500",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "167004",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "46L93AV",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9251034",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Neurosurgery - Mark W. Fox, M.D., FACS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan
• Avera McKennan

• Neurological Surgery Physician in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Neurological Surgery Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; 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.