NPIMap

Organization Active NPI

Avera McKennan

  • Long Term Care Pharmacy
  • Sioux Falls, SD
National Provider Identifier
1669871000
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
100-1994 Issued in SD
Legal business name
AVERA MCKENNAN
Practice address
4101 W Memory Circle
Ste 120
Sioux Falls, SD 57107-6504
Phone
(855) 322-6922
Fax
(855) 971-3544
NPI assigned
Aug 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Authorized official

Name
Ronald Joseph Place, MD
Title
President/Ceo
Phone
(605) 322-7903

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X 100-1994 SD Primary

Addresses

Primary practice location

4101 W Memory Circle
Ste 120
Sioux Falls, SD 57107-6504

Mailing address

3820 N Potsdam Ave Ste 2
Sioux Falls, SD 57104-7057
Phone (605) 322-1450

Other practice location 1

3820 N Potsdam Ave Ste 2
Sioux Falls, SD 57104-7057
Phone (605) 322-1450

Other identifiers 1

IdentifierTypeStateIssuer
2147429OtherPK

Other names 1

  • Avera Long Term Care Pharmacy Doing business as

Other NPIs on the same Medicare enrollment 6

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081124000161 SD Part B Supplier - Mass Immunization (Roster Biller Only) 0345157103 6 other NPIs on this enrollment
Practice locations: Aberdeen, SD; Sioux Falls, SD
O20150310002111 SD DME Supplier - Pharmacy 0345157103 Practice locations: Sioux Falls, SD

All facility ownership & control disclosures 9

Medicare enrollment files

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

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3820 N Potsdam Ave
Ste 2
Sioux Falls, SD 57104
Phone (605) 322-1450

4101 W Memory Cir
Ste 120
Sioux Falls, SD 57107
Phone (605) 322-1450

911 E 20th St
Ste 500
Sioux Falls, SD 57105
Phone (605) 322-7600

NPI Registry JSON

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1669871000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3820 N POTSDAM AVE STE 2",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571047057",
            "telephone_number": "605-322-1450",
            "fax_number": "605-322-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 W MEMORY CIRCLE",
            "address_2": "STE 120",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571076504",
            "telephone_number": "855-322-6922",
            "fax_number": "855-971-3544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3820 N Potsdam Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571047057",
            "country_code": "US",
            "telephone_number": "605-322-1450",
            "fax_number": "605-322-1451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-21",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "PLACE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "SD",
            "license": "100-1994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147429",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Long Term Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Long Term Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.