NPIMap

Organization Active NPI

Avera Marshall

Doing business as Avera Medical Group Carlson

  • Multi-Specialty Clinic/Center
  • Marshall, MN
National Provider Identifier
1407330301
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
AVERA MARSHALL
Doing business as
Avera Medical Group Carlson
Practice address
1521 Carlson St
Marshall, MN 56258-2626
Phone
(507) 532-9631
NPI assigned
Sep 18, 2018
Last updated
Dec 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Authorized official

Name
Debbie Streier
Title
Ceo
Phone
(507) 537-9160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1521 Carlson St
Marshall, MN 56258-2626

Mailing address

1521 Carlson St
Marshall, MN 56258-2626

Other names 1

  • Avera Medical Group Carlson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000219 MN Part B Supplier - Clinic/Group Practice 5799695227 Receives reassigned benefits from 278 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tracy, MN; Springfield, MN; Dawson, MN; Redwood Falls, MN; Minneota, MN; Marshall, MN; Eden Prairie, MN; Canby, MN…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2159579Avera Medical Group Carlson (Coag Clinic)1521 Carlson Street, Marshall, MN 56258Certificate of waiverDec 19, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1407330301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 CARLSON ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562582626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 CARLSON ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562582626",
            "telephone_number": "507-532-9631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MARSHALL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "STREIER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-537-9160"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Carlson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Medical Group Carlson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.