Avera Gettysburg
Organization Active NPI Internal Medicine Physician · Gettysburg, SD
NPI 1366091357 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1366091357
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- AVERA GETTYSBURG
- Practice address
- 606 E Garfield Ave Ste C
Gettysburg, SD 57442-1325 - Phone
- (605) 765-2273
- NPI assigned
- Sep 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Shantel Krebs
- Title
- Interim Ceo
- Phone
- (605) 224-3144
Other NPIs with the same Medicare PAC ID 2
Practitioners 53
-
Connie Belford, C.N.P.
-
Chad J Carda, MD
-
Cindy D. Erwin, P.A.-C.
-
Stephen John Knoble, PA-C
-
Riley Aaron Lamb, M.D.
-
Darci Leisenring, CNP
-
Rena J Robbennolt, CNP
-
Meghan Jeane Torgerson, FNP-C
-
Raymond H Allen, MD
-
Eldon R. Becker, MD
-
Maggie Lynn Bistodeau, PA-C
-
Jennifer Lee Byer, PA-C
-
Paul L Carpenter, MD
-
Sean C Halligan, MD
-
Kasey J Hanson, CNP
-
Darci J Harper, CNP
-
Alyssa Kahler, CNP
-
Brittany Bo Kerr, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191025000756 | SD | Part B Supplier - Clinic/Group Practice | 4284619362 |
Receives reassigned benefits from 52 practitioners Practice locations: Gettysburg, SD |
National Provider Directory
Locations
606 E Garfield Ave
Gettysburg, SD 57442
Phone (605) 765-2273
606 E Garfield Ave
Ste C
Gettysburg, SD 57442
Phone (605) 765-2273
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
606 E Garfield Ave Ste C
Gettysburg, SD 57442-1325
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-4933
Other names
- Avera Medical Group Gettysburg
Other providers in Gettysburg, SD
- Avera Gettysburg
- Avera Gettysburg
- Avera Gettysburg
- Jenny Renee Beetsch
- Connie Belford
- Ethan David Burdman
All providers in Gettysburg, SD · Internal Medicine Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.