NPIMap

Organization Active NPI

Avera McKennan

  • Occupational Medicine Physician
  • Sioux Falls, SD
National Provider Identifier
1700905650
Registry record updated Jun 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
5335 Issued in SD
Legal business name
AVERA MCKENNAN
Practice address
4928 N Cliff Ave
Sioux Falls, SD 57104-0563
Phone
(605) 332-5100
Fax
(605) 322-5101
NPI assigned
Mar 29, 2007
Organization subpart
Yes
Parent organization
AVERA MCKENNANAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2013

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

Authorized official

Name
Julie Norton
Title
Sr VP Finance
Phone
(605) 322-7818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083X0100X 5335 SD Primary

Addresses

Primary practice location

4928 N Cliff Ave
Sioux Falls, SD 57104-0563

Mailing address

4928 N Cliff Ave
Sioux Falls, SD 57104-0563
Phone (605) 332-5100

Other identifiers 2

IdentifierTypeStateIssuer
33732OtherIAIA MEDICAL LICENSE
5335OtherSDSD MEDICAL LICENSE

Other names 1

  • AMG Occupational Medicine Sioux Falls Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avera McKennan Hosp105 organizations share this tax ID, including this one
Part of
Avera McKennan Hosp

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370217600000",
    "number": "1700905650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4928 N CLIFF AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571040563",
            "telephone_number": "605-332-5100",
            "fax_number": "605-322-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4928 N CLIFF AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571040563",
            "telephone_number": "605-332-5100",
            "fax_number": "605-322-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA MCKENNAN",
        "enumeration_date": "2007-03-29",
        "last_updated": "2013-06-03",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "605-322-7818"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "SD",
            "license": "5335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA MEDICAL LICENSE",
            "identifier": "33732",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SD MEDICAL LICENSE",
            "identifier": "5335",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMG Occupational Medicine Sioux Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.