Avera Queen of Peace
Organization Active NPI Family Medicine Physician · Mitchell, SD
NPI 1124308010 · NPPES record last updated Jan 22, 2026
Key facts
- NPI
- 1124308010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AVERA QUEEN OF PEACE
- Practice address
- 1900 Grassland Dr
Mitchell, SD 57301-6205 - Phone
- (605) 995-7000
- Fax
- (605) 995-7052
- NPI assigned
- Aug 23, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- AVERA HEALTH
Authorized official
- Name
- Hilary Rae Rockwell, MD
- Title
- Regional President/Ceo
- Phone
- (605) 995-2250
Other NPIs on the same Medicare enrollment 31
Practitioners 12
-
John Andrew Berg, MD
-
Tanya Hagen-Lee, CNP
-
Teresa Ann Jatczak, CNP
-
Darren Manthey, MD
-
Scott Gregory Vankeulen, M.D.
-
Christopher C Marek, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Locations
818 W Havens Ave
Mitchell, SD 57301
Phone (605) 996-7526
818 W Havens Ave
Ste 900
Mitchell, SD 57301
Phone (605) 996-7526
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1900 Grassland Dr
Mitchell, SD 57301-6205
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-4933
Other practice location 1
818 W Havens Ave Ste 900
Mitchell, SD 57301-3830
Phone (605) 996-7526
Other practice location 2
818 W Havens Ave Ste 800
Mitchell, SD 57301-3830
Phone (605) 996-7526
Other names
- Avera Family Medicine Mitchell/AveraNOW
- Avera Medical Group Family Medicine Mitchell/AveraNOW
- Avera Mitchell Clinic
Other providers in Mitchell, SD
- Avera Home Medical Equipment, LLC
- Avera McKennan
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
All providers in Mitchell, SD · Family Medicine Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.