NPIMap

Organization Active NPI

Avera Gettysburg

Doing business as Avera Medical Group Gettysburg

  • Internal Medicine Physician
  • Gettysburg, SD
National Provider Identifier
1366091357
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
AVERA GETTYSBURG
Doing business as
Avera Medical Group Gettysburg
Practice address
606 E Garfield Ave Ste C
Gettysburg, SD 57442-1325
Phone
(605) 765-2273
NPI assigned
Sep 11, 2019
Last updated
Apr 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Authorized official

Name
Shantel Krebs
Title
Interim Ceo
Phone
(605) 224-3144

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 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 1

  • Avera Medical Group Gettysburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191025000756 SD Part B Supplier - Clinic/Group Practice 4284619362 Receives reassigned benefits from 52 practitioners
Practice locations: Gettysburg, SD

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • Avera Gettysburg

    dba Avera Missouri River Health Center

    • Critical Access Hospital
    • Gettysburg, SD
    • NPI 1003887266

    4284619362

    Same PAC ID
  • Avera Gettysburg

    dba Avera Missouri River Health Center (Swingbed)

    • Medicare Defined Swing Bed Hospital Unit
    • Gettysburg, SD
    • NPI 1881754497

    4284619362

    Same PAC ID

National Provider Directory

National Provider Directory

Locations

606 E Garfield Ave
Ste C
Gettysburg, SD 57442
Phone (605) 765-2273

Practitioners & affiliated clinicians

Practitioners 53

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.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1366091357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86370",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571186370",
            "telephone_number": "605-322-4933",
            "fax_number": "605-504-9489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E GARFIELD AVE STE C",
            "city": "GETTYSBURG",
            "state": "SD",
            "postal_code": "574421325",
            "telephone_number": "605-765-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA GETTYSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-11",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "KREBS",
        "authorized_official_first_name": "SHANTEL",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "605-224-3144"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Gettysburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Medical Group Gettysburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gettysburg, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.