Avera McKennan

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

43D0658878 Issued in SD

Legal business name

AVERA MCKENNAN

Doing business as

Avera McKennan Regional Lab

Practice address

1301 S Cliff Ave
Regional Lab
Sioux Falls, SD 57105-1005

Phone

(605) 322-7187

Fax

(605) 322-7183

NPI assigned

Jul 26, 2006

Last updated

Nov 12, 2020By 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

David Flicek

Title

President/Ceo

Phone

(605) 322-7916

Specialties & licenses 1

Addresses

Other names 1

• Avera McKennan Regional Lab Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Avera McKennan

  dba Avera Institute for Human Genetics

  • Clinical Medical Laboratory
  • Sioux Falls, SD
  • NPI 1528627361

  O20040205000938

  Same enrollment

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

CLIA laboratory certificates

Tax ID family

Beresford Neuropsychiat105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

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

• Avera Gregory

  • Critical Access Hospital
  • Gregory, SD
  • NPI 1770939530
  NPD tax ID
• Avera McKennan

  dba Avera Flandreau Hospital Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Flandreau, SD
  • NPI 1770690398
  NPD tax ID
• Avera McKennan

  dba Avera McKennan Renal Transplant Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sioux Falls, SD
  • NPI 1770753246
  NPD tax ID
• Avera McKennan

  • Home Health Agency
  • Marion, SD
  • NPI 1780887604
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group Family Wellness

  • Psychiatry Physician
  • Sioux Falls, SD
  • NPI 1821478249
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group Pediatric Critical Care Services

  • Pediatric Critical Care Medicine Physician
  • Sioux Falls, SD
  • NPI 1821686932
  NPD tax ID
• Avera McKennan

  dba Avera Tea Medical Clinic

  • Nurse Practitioner
  • Tea, SD
  • NPI 1831230408
  NPD tax ID
• Avera McKennan

  dba Avera Rehabilitation Associates

  • Physical Medicine & Rehabilitation Physician
  • Sioux Falls, SD
  • NPI 1841427770
  NPD tax ID
• Avera McKennan

  dba Avera Long Term Care Pharmacy Aberdeen

  • Long Term Care Pharmacy
  • Aberdeen, SD
  • NPI 1841948643
  NPD tax ID
• Avera McKennan

  dba Avera Plaza 2 Pharmacy

  • Pharmacy
  • Sioux Falls, SD
  • NPI 1861110876
  NPD tax ID
• Avera McKennan

  dba Avera McKennan Hospital and University Health Center - Placement

  • General Acute Care Hospital
  • Sioux Falls, SD
  • NPI 1881804458
  NPD tax ID
• Avera McKennan

  dba Avera Dialysis Brookings

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brookings, SD
  • NPI 1891055174
  NPD tax ID

Locations

All facility ownership & control disclosures 9

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

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1891718136",
    "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.",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-7187",
            "fax_number": "605-322-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S CLIFF AVE",
            "address_2": "REGIONAL LAB",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051005",
            "telephone_number": "605-322-7187",
            "fax_number": "605-322-7183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6100 S Louise Ave",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571086029",
            "country_code": "US",
            "telephone_number": "605-322-7187",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2100 S Marion Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571063647",
            "country_code": "US",
            "telephone_number": "605-322-7187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "FLICEK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7916"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SD",
            "license": "43D0658878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera McKennan Regional Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera McKennan Regional Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Avera McKennan (Avera Rehabilitation Associates)
• Avera McKennan (Avera Medical Group Family Health Center)
• Avera McKennan (Avera Medical Group Optometry)
• Avera McKennan (Avera Plaza 2 Pharmacy)
• Avera McKennan (Avera McKennan Hospital and University Health Center - Placement)
• Avera McKennan (Avera Community Health Resource Program)
• Avera McKennan (Avera Adolescent Addiction Center)
• Avera McKennan (Avera Medical Group McGreevy Washington School)
• Avera McKennan (Avera Medical Group Gynecologic Oncology Sioux Falls)
• Avera McKennan (Avera Medical Group Comprehensive Breast Care Sioux Falls)

• Clinical Medical Laboratory in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Clinical Medical Laboratory in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.
• 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.