NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera Dialysis Brookings

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brookings, SD
National Provider Identifier
1891055174
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
10563 Issued in SD
Legal business name
AVERA MCKENNAN
Doing business as
Avera Dialysis Brookings
Practice address
300 22ND Ave
Suite 101
Brookings, SD 57006-2480
Phone
(605) 696-7760
Fax
(605) 696-7765
NPI assigned
May 21, 2012
Last updated
Jul 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
Daivd Flicek
Title
President/Ceo
Phone
(605) 322-7915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 10563 SD Primary

Addresses

Primary practice location

300 22ND Ave
Suite 101
Brookings, SD 57006-2480

Mailing address

PO Box 5045
Attn: P.F.S Prov Enrollment
Sioux Falls, SD 57117-5045
Phone (605) 322-6428

Other names 1

  • Avera Dialysis Brookings Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120801000865 SD Part A Provider - End-Stage Renal Disease Facility (ESRD) 0345157103 Practice locations: Brookings, SD

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Avera Dialysis - BrookingsCCN 433510
Overall star rating
5.0 of 5
Ownership
Non-profit
Certified
Sep 6, 2012
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
7

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Presentation Health Sys105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

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

View all 23

Ownership & related parties

All facility ownership & control disclosures 9

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1891055174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045",
            "address_2": "ATTN: P.F.S PROV ENROLLMENT",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428",
            "fax_number": "605-322-6499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 22ND AVE",
            "address_2": "SUITE 101",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062480",
            "telephone_number": "605-696-7760",
            "fax_number": "605-696-7765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "FLICEK",
        "authorized_official_first_name": "DAIVD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7915"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SD",
            "license": "10563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Dialysis Brookings",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Dialysis Brookings",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.