Avera McKennan

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

AVERA MCKENNAN

Doing business as

Avera Medical Group Worthington

Practice address

1216 Ryans Rd
Worthington, MN 56187-1722

Phone

(507) 372-2921

Fax

(507) 372-5789

NPI assigned

Jan 15, 2008

Last updated

Apr 1, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

AVERA MCKENNANAs reported in NPPES

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

Authorized official

Name

Kelli Van Grouw

Title

Clinic Manager

Phone

(507) 372-2921

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Avera Medical Group Worthington Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Presentation Health Sys

Member of 1

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

• Avera McKennan

  dba Avera Rosebud Country Care Center

  • Skilled Nursing Facility
  • Gregory, SD
  • NPI 1952330706

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1700062213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 RYANS RD",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871722",
            "telephone_number": "507-372-2921",
            "fax_number": "507-372-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 RYANS RD",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871722",
            "telephone_number": "507-372-2921",
            "fax_number": "507-372-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA MCKENNAN",
        "enumeration_date": "2008-01-15",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "VAN GROUW",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "507-372-2921"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "951015000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690009299",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "48941WO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Worthington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Avera Marshall (Avera Medical Group Optometry Worthington)
• Avera McKennan (Avera Medical Group Fulda)
• Avera McKennan (Avera Medical Group Optometry Worthington)
• Avera McKennan (Avera Medical Group Worthington)
• Avera McKennan (Avera Medical Group Lakefield)
• Avera McKennan (Avera Medical Group Heron Lake)
• Avera McKennan (Avera Medical Group Worthington Surgery Center)
• Naomi Noelle Bach
• Heather Lanae Bajema, PSY.D.
• Bassel Bardan, MD

• Clinical Medical Laboratory in Worthington, MN
• Providers in Worthington, MN by specialty
• Clinical Medical Laboratory in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.