NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera Medical Group Flandreau

  • Rural Health Clinic/Center
  • Flandreau, SD
National Provider Identifier
1619948007
Registry record updated Feb 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AVERA MCKENNAN
Doing business as
Avera Medical Group Flandreau
Practice address
212 North Prairie Street
Flandreau, SD 57028-1296
Phone
(605) 997-2471
Fax
(605) 997-2418
NPI assigned
Feb 1, 2006
Last updated
Feb 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2011

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

Authorized official

Name
Mrs. Julie N Norton
Title
Senior Vice President of Finance
Phone
(605) 322-6375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

212 North Prairie Street
Flandreau, SD 57028-1296

Mailing address

212 North Prairie Street
Flandreau, SD 57028-1296
Phone (605) 997-2471

Other identifiers 12

IdentifierTypeStateIssuer
10025371500MedicaidNE
106366608OtherSDDEPARTMENT OF LABOR
126277700MedicaidMN
9216572OtherSDDAKOTACARE
10025485500OtherNERHC MEDICAID NE
5340320MedicaidSD
659S2FLOtherMNBCBS OF MN
4995978OtherSDBCBS OF SOUTH DAKOTA
95027OtherSDHEALTHPARTNERS
0571919MedicaidIA
659S2FLOtherMNCC SYSTEMS BLUE PLUS
80484900MedicaidWI

Other names 1

  • Avera Medical Group Flandreau Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD2 enrollments

Enrollment records 2

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
O20060919000441 SD Part A Provider - Rural Health Clinic 0345157103 Practice locations: Flandreau, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619948007. Details of each certification follow.

Rural health clinic certification: CCN 433429

Legal name
AVERA MCKENNAN
Doing business as
AVERA MEDICAL GROUP FLANDREAU
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2006
Last certification
Jun 13, 2024
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
May 25, 1923 in SD
Enrollment address
212 N Prairie St
Flandreau, SD 57028-1243
Related CCNs
431310

Facilities connected through Provider of Services related, parent or unit certification numbers.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alisa L Reindl Individual Corporate DirectorBoard Member Jul 1, 2021
Van Fishback Individual Corporate DirectorBoard Member Jul 1, 2018
Candyce C Chrystal Individual Corporate DirectorBoard Member Jul 1, 2023
Harriet Yocum Individual Corporate DirectorBoard Member Jul 1, 2021
Jennifer Bunkers Individual Corporate DirectorBoard Member Jul 1, 2021
Randy Knecht Individual Corporate DirectorBoard Member Jul 1, 2018
Joseph Thomas Biegler Individual Corporate DirectorBoard Member Jul 1, 2016
Jawad Nazir Individual Corporate DirectorBoard Member Jul 1, 2020
Lucille F Welbig Individual Corporate DirectorBoard Member Jul 1, 2016
Joseph Patrick Costello Individual Corporate DirectorBoard Member Jul 1, 2017
Laurie Knutson Individual Corporate DirectorBoard Member Jul 1, 2017
Brenda K Kallemeyn Individual Corporate DirectorBoard Member Jul 1, 2023
Jennifer Kirby Individual Corporate DirectorBoard Member Jul 1, 2020
Alejandro Ramirez Individual Corporate DirectorBoard Member Jul 1, 2016
Ronald J. Place Individual Corporate OfficerPresident/Ceo Jun 5, 2023
Operational/Managerial Control Jun 5, 2023
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
W-2 Managing Employee Jul 1, 2009
Mary C Curran Individual Corporate DirectorBoard Member Jul 1, 2018
Bobby Lynn Sutton Individual Corporate OfficerPresident/Ceo Avera Health Jun 18, 2018
Avera Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Jun 15, 1992 100%
Operational/Managerial Control Jun 15, 1992
Roxanne P Seifert Individual Corporate DirectorBoard Member Jul 1, 2022
Jeffrey Gordon Individual Corporate DirectorBoard Member Jul 1, 2023
Cristina a Hill Jensen Individual Corporate DirectorBoard Member Jul 1, 2018
Benjamin M Solomon Individual Corporate DirectorBoard Member Jul 1, 2022

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakes Regional HealthcareSpirit Lake, IA, CCN 160124 Hospital Operational/Managerial Control Oct 24, 2022
Avera Heart Hospital of South DakotaSioux Falls, SD, CCN 430095 Hospital 5% Or Greater Direct Ownership Interest (33.33%) Oct 1, 2010
Avera Holy Family HospitalEstherville, IA, CCN 161351 Hospital Operational/Managerial Control Oct 6, 1994
Avera Holy Family HospitalEstherville, IA, CCN 16Z351 Hospital Operational/Managerial Control Jan 1, 2007
Lakes Regional HealthcareSpirit Lake, IA, CCN 16U124 Hospital Operational/Managerial Control Oct 24, 2022
United Living CommunityBrookings, SD, CCN 435079 Skilled nursing facility Operational/Managerial Control Nov 15, 2005
Freeman Regional Health ServicesMenno, SD, CCN 433444 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesBridgewater, SD, CCN 433443 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesMarion, SD, CCN 433445 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011

Facilities with the same owner 90

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 90

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297814400000",
    "number": "1619948007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 NORTH PRAIRIE STREET",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "570281296",
            "telephone_number": "605-997-2471",
            "fax_number": "605-997-2418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 NORTH PRAIRIE STREET",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "570281296",
            "telephone_number": "605-997-2471",
            "fax_number": "605-997-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2011-02-16",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "605-322-6375",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025371500",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "106366608",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126277700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9216572",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHC MEDICAID NE",
            "identifier": "10025485500",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5340320",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "659S2FL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF SOUTH DAKOTA",
            "identifier": "4995978",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "95027",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0571919",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CC SYSTEMS BLUE PLUS",
            "identifier": "659S2FL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80484900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Flandreau",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flandreau, SD

Sources for this page

Verify at the official NPI Registry.