Avera McKennan

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

AVERA MCKENNAN

Doing business as

Avera Medical Group Tea

Practice address

725 E Figzel CT
Suite 100
Tea, SD 57064-2276

Phone

(605) 368-9899

Fax

(605) 368-5089

NPI assigned

Feb 23, 2006

Last updated

May 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Julie N Norton

Title

Sr Vice President of Finance

Phone

(605) 322-6375

Specialties & licenses 2

Addresses

Other names 1

• Avera Medical Group Tea Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Avera Home Medical Equipment, LLC

  • Durable Medical Equipment & Medical Supplies
  • Parkston, SD
  • NPI 1568530566

  Member Of

  NPD member
• Avera Home Medical Equipment, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pierre, SD
  • NPI 1669548616

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1376519116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86430",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571186430",
            "telephone_number": "605-322-4900",
            "fax_number": "605-322-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 E FIGZEL CT",
            "address_2": "SUITE 100",
            "city": "TEA",
            "state": "SD",
            "postal_code": "570642276",
            "telephone_number": "605-368-9899",
            "fax_number": "605-368-5089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SR VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "605-322-6375"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Tea",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael James Adler, MD
• Nicole Altman, PMHNP-BC
• Gregory Franklin Alvine, MD
• Griffin Gregory Anderson
• Aurelia Group PLLC (Golden Smiles Dental Studio)
• Avera McKennan (Avera Tea Medical Clinic)
• Keith M Baumgarten, MD
• Maggie Lynn Bistodeau, PA-C
• James T Brunz, MD
• Carrie Hanson

• Family Medicine Physician in Tea, SD
• Providers in Tea, SD by specialty
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.