NPIMap

Organization Active NPI

Avera Queen of Peace

Doing business as Avera Bariatric Center

  • Specialist
  • Mitchell, SD
National Provider Identifier
1245522622
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
AVERA QUEEN OF PEACE
Doing business as
Avera Bariatric Center
Practice address
2200 N Kimball St
Mitchell, SD 57301-1113
Phone
(605) 996-5482
NPI assigned
May 4, 2011
Last updated
May 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Authorized official

Name
Mr. Patrick J. Clark
Title
Senior Vice President and Cfo
Phone
(605) 995-2251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

2200 N Kimball St
Mitchell, SD 57301-1113

Mailing address

2200 N Kimball St
Mitchell, SD 57301-1113
Phone (605) 996-5482

Other names 1

  • Avera Bariatric Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory

Locations

2200 N Kimball St
Mitchell, SD 57301
Phone (605) 996-1216

NPI Registry JSON

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1245522622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 N KIMBALL ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011113",
            "telephone_number": "605-996-5482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 N KIMBALL ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011113",
            "telephone_number": "605-996-5482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "605-995-2251",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Bariatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; 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.