NPIMap

Organization Active NPI

Avera Colman Medical Clinic

  • Family Medicine Physician
  • Colman, SD
National Provider Identifier
1194873851
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4884 Issued in SD
Legal business name
AVERA COLMAN MEDICAL CLINIC
Practice address
109 N. Main
Colman, SD 57017
NPI assigned
Jan 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Marilyn Hogan
Title
RN Clinic Manager
Phone
(605) 428-5446

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4884 SD Primary
Family Medicine Physician 207Q00000X 5054 SD

Addresses

Primary practice location

109 N. Main
Colman, SD 57017

Mailing address

109 N. Main
Colman, SD 57017

Other identifiers 2

IdentifierTypeStateIssuer
5610960MedicaidSD
5611290MedicaidSD

National Provider Directory

National Provider Directory

Locations

109 N Main
Colman, SD 57017

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194873851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N. MAIN",
            "city": "COLMAN",
            "state": "SD",
            "postal_code": "57017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N. MAIN",
            "city": "COLMAN",
            "state": "SD",
            "postal_code": "57017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA COLMAN MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOGAN",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "RN CLINIC MANAGER",
        "authorized_official_telephone_number": "605-428-5446"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "4884",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "5054",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5610960",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5611290",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colman, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.