NPIMap

Organization Active NPI

Avera St. Mary'S

  • Medical Specialty Clinic/Center
  • Pierre, SD
National Provider Identifier
1124464128
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
AVERA ST. MARY'S
Practice address
801 E Sioux Ave
Pierre, SD 57501-3323
Phone
(605) 224-3100
Fax
(605) 224-8339
NPI assigned
May 16, 2013
Organization subpart
Yes
Parent organization
AVERA ST. MARY'S HOSPITAL CHILD ASSESSMENT CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mikel Holland
Title
Ceo/President
Phone
(605) 224-3144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

801 E Sioux Ave
Pierre, SD 57501-3323

Mailing address

PO Box 5045
Cbo Palm Place PRV Enrlmt
Sioux Falls, SD 57117-5045
Phone (605) 322-6428

Other identifiers 1

IdentifierTypeStateIssuer
5405080MedicaidSD

Other names 1

  • Avera St. Mary's Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jon Vandermaten PA C11 organizations share this tax ID, including this one
Part of
Jon Vandermaten PA C

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1124464128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045",
            "address_2": "CBO PALM PLACE PRV ENRLMT",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428",
            "fax_number": "605-224-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E SIOUX AVE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013323",
            "telephone_number": "605-224-3100",
            "fax_number": "605-224-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST. MARY'S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA ST. MARY'S HOSPITAL CHILD ASSESSMENT CENTER",
        "enumeration_date": "2013-05-16",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "MIKEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "605-224-3144"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5405080",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera St. Mary's Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera St. Mary's Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pierre, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.