NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera Medical Group McGreevy 69th & Western

  • Family Medicine Physician
  • Sioux Falls, SD
National Provider Identifier
1134324445
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AVERA MCKENNAN
Doing business as
Avera Medical Group McGreevy 69th & Western
Practice address
1910 W 69TH St
Sioux Falls, SD 57108-5612
Phone
(605) 322-5200
Fax
(605) 322-5205
NPI assigned
Jun 18, 2007
Last updated
May 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Julie N Norton
Title
Sr Vice President of Finance
Phone
(605) 322-6375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1910 W 69TH St
Sioux Falls, SD 57108-5612

Mailing address

PO Box 86430
Sioux Falls, SD 57118-6430
Phone (605) 322-4900

Other names 1

  • Avera Medical Group McGreevy 69th & Western Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D1069059Avera Medical Group McGreevy 69TH & Western1910 West 69TH Street, Sioux Falls, SD 57108AccreditationJun 23, 2028

National Provider Directory

National Provider Directory

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1134324445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86430",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571186430",
            "telephone_number": "605-322-4900",
            "fax_number": "605-322-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571085612",
            "telephone_number": "605-322-5200",
            "fax_number": "605-322-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SR VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "605-322-6375"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group McGreevy 69th & Western",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.