Avera McKennan

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

4653 Issued in SD

Legal business name

AVERA MCKENNAN

Doing business as

Avera Neurosurgery - Daniel G. Tynan, M.D.

Practice address

1100 E 21St St
Ste 600
Sioux Falls, SD 57105-1020

Phone

(605) 322-4800

Fax

(605) 322-4801

NPI assigned

Aug 7, 2007

Last updated

Mar 30, 2010By 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

Senior VP of Finance

Phone

(605) 322-6375

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Avera Neurosurgery - Daniel G. Tynan, M.D. Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Practitioners 3

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.

• Kristie L Goens, CNP

  • Family Nurse Practitioner
  • Watertown, SD
  • NPI 1245204957
  NPD (past)
• Julie J Dueis, PA-C

  • Physician Assistant
  • Yakima, WA
  • NPI 1811957178
  NPD (past)
• Gary J Kadlec, N.P.

  • Nurse Practitioner
  • Rochester, MN
  • NPI 1215993407
  NPD (past)

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269907200000",
    "number": "1649461369",
    "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",
            "telephone_number": "605-322-7510",
            "fax_number": "605-322-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E 21ST ST",
            "address_2": "STE 600",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051020",
            "telephone_number": "605-322-4800",
            "fax_number": "605-322-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2010-03-30",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SENIOR VP OF FINANCE",
        "authorized_official_telephone_number": "605-322-6375"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "SD",
            "license": "4653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025595900",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "6I362AV",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9251035",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SD",
            "identifier": "4992604",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Neurosurgery - Daniel G. Tynan, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Neurological Surgery Physician in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Neurological Surgery Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; 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.