Active NPI
Avera McKennan
Doing business as Avera Medical Group Kennebec Area
- Family Medicine Physician
- Kennebec, SD
National Provider Identifier
1356788491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- AVERA MCKENNAN
- Doing business as
- Avera Medical Group Kennebec Area
- Practice address
- 120 South Main Street
Kennebec, SD 57544 - Phone
- (605) 869-2872
- Fax
- (605) 869-2873
- NPI assigned
- May 30, 2013
- Last updated
- May 30, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Julie N. Norton
- Title
- Sr. VP Finance /Cfo
- Phone
- (605) 322-6375
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
120 South Main Street
Kennebec, SD 57544
Mailing address
120 South Main Street
Kennebec, SD 57544
Phone (605) 869-2872
Other names 1
- Avera Medical Group Kennebec Area
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000117 | SD | Part B Supplier - Clinic/Group Practice | 0345157103 |
Receives reassigned benefits from 1,418 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Presentation Health Sys
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.
-
dba Avera McKennan Behavioral Health Services
- Psychiatric Hospital Unit
- Sioux Falls, SD
- NPI 1225201205
-
dba Avera Gregory Dialysis Unit
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Gregory, SD
- NPI 1255435814
-
dba Avera Long Term Care Pharmacy Rapid City
- Long Term Care Pharmacy
- Rapid City, SD
- NPI 1306601794
-
dba Avera 7th Avenue Pharmacy
- Community/Retail Pharmacy
- Sioux Falls, SD
- NPI 1316463219
-
dba Milbank Area Hospital/Avera Health- Swingbed
- Medicare Defined Swing Bed Hospital Unit
- Milbank, SD
- NPI 1326154220
-
dba Avera McKennan Outpatient Therapy Services - Brandon
- Physical Therapy Clinic/Center
- Brandon, SD
- NPI 1346494697
-
dba Avera Medical Group McGreevy Dawley Farm
- Family Medicine Physician
- Sioux Falls, SD
- NPI 1346512266
-
dba Avera Medical Group Palliative Medicine Sioux Falls
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Sioux Falls, SD
- NPI 1356629497
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Physician Assistant
- Watertown, SD
- NPI 1487973525
-
- Family Nurse Practitioner
- Mitchell, SD
- NPI 1609358035
-
- Family Medicine Physician
- Dell Rapids, SD
- NPI 1760451660
-
- Family Nurse Practitioner
- Memphis, TN
- NPI 1508892241
-
- Physician Assistant
- Saint Cloud, MN
- NPI 1235716598
-
- Family Nurse Practitioner
- Larchwood, IA
- NPI 1275981110
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369872000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1369872000000",
"number": "1356788491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 SOUTH MAIN STREET",
"city": "KENNEBEC",
"state": "SD",
"postal_code": "57544",
"telephone_number": "605-869-2872",
"fax_number": "605-869-2873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 SOUTH MAIN STREET",
"city": "KENNEBEC",
"state": "SD",
"postal_code": "57544",
"telephone_number": "605-869-2872",
"fax_number": "605-869-2873"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVERA MCKENNAN",
"organizational_subpart": "NO",
"enumeration_date": "2013-05-30",
"last_updated": "2013-05-30",
"status": "A",
"authorized_official_last_name": "NORTON",
"authorized_official_first_name": "JULIE",
"authorized_official_middle_name": "N.",
"authorized_official_title_or_position": "SR. VP FINANCE /CFO",
"authorized_official_telephone_number": "605-322-6375",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Avera Medical Group Kennebec Area",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Kennebec, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; 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.