NPIMap

Individual provider Active NPI

Sara T Granville, PA

  • Physician Assistant
  • Pierre, SD
National Provider Identifier
1457670366
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
745 Issued in SD
Practice address
100 Mac LN
Avera Medical Group Pierre
Pierre, SD 57501
Phone
(605) 945-5202
Fax
(605) 945-5094
NPI assigned
May 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 745 SD Primary

Addresses

Primary practice location

100 Mac LN
Avera Medical Group Pierre
Pierre, SD 57501

Mailing address

100 Mac LN
Avera Medical Group Pierre
Pierre, SD 57501
Phone (605) 945-5202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100623000583 SD Practitioner - Physician Assistant 9931230786 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennan 957 clinicians
Avera St Marys 97 clinicians

Practice addresses (Care Compare)

310 22ND Ave
Brookings, SD 57006-2474

801 E Sioux Ave
Pierre, SD 57501-3323
Phone (605) 224-5901

Hospital & facility affiliations

  • Avera St Mary'S Hospital Hospital, Pierre, SD, CCN 430015
  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
745SDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St Marys CurrentSince Mar 1, 2013 Accepting new patients
Avera McKennan CurrentSince May 24, 2010 Accepting new patients
Avera McKennan CurrentSince May 24, 2010 Accepting new patients
Pediatric Hematology Oncology Pharmacy LTC Past Accepting new patients
Pediatric Hematology Clinic LTD Past Accepting new patients

Locations

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

100 Mac Ln
Pierre, SD 57501
Phone (605) 224-5901

1315 S Cliff Ave
Ste 2000
Sioux Falls, SD 57105
Phone (605) 322-5800

Interoperability endpoints

  • Direct secure messaging: sara.granville@avera.sdhealthlink.net

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 25

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334275200000",
    "number": "1457670366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAC LN",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-945-5202",
            "fax_number": "605-945-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAC LN",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-945-5202",
            "fax_number": "605-945-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANVILLE",
        "first_name": "SARA",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-18",
        "last_updated": "2012-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.