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Organization Active NPI

Avera McKennan

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Gregory, SD
National Provider Identifier
1255435814
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
AVERA MCKENNAN
Practice address
110 S Logan Ave
Gregory, SD 57533-1614
Phone
(605) 835-8394
NPI assigned
Sep 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Ronald Joseph Place, MD
Title
Ceo/President
Phone
(605) 322-7903

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary
Critical Access Hospital 282NC0060X 54875 SD

Addresses

Primary practice location

110 S Logan Ave
Gregory, SD 57533-1614

Mailing address

PO Box 408
400 Park Ave.
Gregory, SD 57533-0408
Phone (605) 835-8394

Other practice location 1

400 Park Ave.
Gregory, SD 57533-0408
Phone (605) 835-8394 ext. 183

Other identifiers 1

IdentifierTypeStateIssuer
5500350MedicaidSD

Other names 1

  • Avera Gregory Dialysis Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090319000287 SD Part A Provider - End-Stage Renal Disease Facility (ESRD) 0345157103 Practice locations: Gregory, SD

National Provider Directory

National Provider Directory
Tax ID family
Avera McKennan Hosp105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakes Regional HealthcareSpirit Lake, IA, CCN 160124 Hospital Operational/Managerial Control Oct 24, 2022
Avera Heart Hospital of South DakotaSioux Falls, SD, CCN 430095 Hospital 5% Or Greater Direct Ownership Interest (33.33%) Oct 1, 2010
Avera Holy Family HospitalEstherville, IA, CCN 161351 Hospital Operational/Managerial Control Oct 6, 1994
Avera Holy Family HospitalEstherville, IA, CCN 16Z351 Hospital Operational/Managerial Control Jan 1, 2007
Lakes Regional HealthcareSpirit Lake, IA, CCN 16U124 Hospital Operational/Managerial Control Oct 24, 2022
United Living CommunityBrookings, SD, CCN 435079 Skilled nursing facility Operational/Managerial Control Nov 15, 2005
Freeman Regional Health ServicesMenno, SD, CCN 433444 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesBridgewater, SD, CCN 433443 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesMarion, SD, CCN 433445 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Avera Gregory Healthcare Ctr DialysisCCN 432308
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
May 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
5

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1255435814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 408",
            "address_2": "400 PARK AVE.",
            "city": "GREGORY",
            "state": "SD",
            "postal_code": "575330408",
            "telephone_number": "605-835-8394",
            "fax_number": "605-835-9422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S LOGAN AVE",
            "city": "GREGORY",
            "state": "SD",
            "postal_code": "575331614",
            "telephone_number": "605-835-8394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Park Ave.",
            "address_purpose": "LOCATION",
            "city": "Gregory",
            "state": "SD",
            "postal_code": "575330408",
            "country_code": "US",
            "telephone_number": "605-835-8394 x183",
            "fax_number": "605-835-9422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "PLACE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "605-322-7903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "54875",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500350",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Gregory Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Gregory Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gregory, SD

Sources for this page

Verify at the official NPI Registry.