Avera McKennan

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

AVERA MCKENNAN

Doing business as

Avera McKennan Campus Pharmacy

Practice address

1325 S Cliff Ave
Suite CP
Sioux Falls, SD 57105-1008

Phone

(605) 322-8326

Fax

(605) 322-8330

NPI assigned

Dec 12, 2006

Last updated

Oct 6, 2023By 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

Ronald Joseph Place, MD

Title

President/Ceo

Phone

(605) 322-7903

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• AVERA MCKENNAN CAMPUS PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Member of 2

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

• Avera Home Medical Equipment, LLC

  • Durable Medical Equipment & Medical Supplies
  • Parkston, SD
  • NPI 1568530566

  Member Of

  NPD member
• Avera Home Medical Equipment, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pierre, SD
  • NPI 1669548616

  Member Of

  NPD member

Locations

All facility ownership & control disclosures 9

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

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.

• Roxanne Chadwell, PHARMD

  • Pharmacist
  • Sioux Falls, SD
  • NPI 1043882921
  NPD (past)
• Mariah Fickbohm

  • Pharmacist
  • Sioux Falls, SD
  • NPI 1992073134
  NPD (past)
• Tyler J Laetsch, PHARMD

  • Pharmacist
  • Sioux Falls, SD
  • NPI 1033788740
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1750442901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 S CLIFF AVE",
            "address_2": "SUITE CP",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051008",
            "telephone_number": "605-322-8326",
            "fax_number": "605-322-8330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S CLIFF AVE",
            "address_2": "SUITE CP",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051008",
            "telephone_number": "605-322-8326",
            "fax_number": "605-322-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SD",
            "license": "1000452",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4304010",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750442901",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8503150",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750442901",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVERA MCKENNAN CAMPUS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AVERA MCKENNAN CAMPUS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Avera McKennan (Avera eCARE)
• Avera McKennan (AMG Occupational Medicine Sioux Falls)
• Avera McKennan (Avera Dialysis Sioux Falls)
• Avera McKennan (Avera Transplant & Liver Surgery Sioux Falls)
• Avera McKennan (Avera McKennan Hospital Neonatal Intensive Care Unit)
• Avera McKennan (Avera Medical Group Behavioral Health Clinic)
• Avera McKennan (Avera Internal Medicine)
• Avera McKennan (Avera McKennan Renal Transplant Center)
• Avera McKennan (Avera Medical Group Family Wellness)
• Avera McKennan (Avera Medical Group Pediatric Critical Care Services)

• Pharmacy in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Pharmacy in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.