NPIMap

Organization Active NPI

Avera McKennan

  • Obesity Medicine (Family Medicine) Physician
  • Sioux Falls, SD
National Provider Identifier
1457096133
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X
Legal business name
AVERA MCKENNAN
Practice address
911 E 20TH St Ste 200
Sioux Falls, SD 57105-1044
Phone
(605) 504-0400
Fax
(605) 504-0401
NPI assigned
Apr 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
David William Flicek
Title
President/Ceo
Phone
(605) 322-7915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QB0002X Primary

Addresses

Primary practice location

911 E 20TH St Ste 200
Sioux Falls, SD 57105-1044

Mailing address

PO Box 86370
Sioux Falls, SD 57118-6370

Other names 1

  • Avera Medical Group Comprehensive Weight Management Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1457096133",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 E 20TH ST STE 200",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051044",
            "telephone_number": "605-504-0400",
            "fax_number": "605-504-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "FLICEK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7915"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Comprehensive Weight Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.