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Organization Active NPI

Avera McKennan

Doing business as Avera Medical Group Spencer

  • Family Medicine Physician
  • Spencer, IA
National Provider Identifier
1902886567
Registry record updated Mar 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AVERA MCKENNAN
Doing business as
Avera Medical Group Spencer
Practice address
116 E 11TH St
Suite 101
Spencer, IA 51301-4364
Phone
(712) 264-3500
Fax
(712) 264-3535
NPI assigned
Jan 19, 2006
Last updated
Mar 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2012

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

Authorized official

Name
Ms. Julie N Norton
Title
V.P. Finance
Phone
(605) 322-6375

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X IA Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X IA
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X IA
Pediatric Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0200X IA

Addresses

Primary practice location

116 E 11TH St
Suite 101
Spencer, IA 51301-4364

Mailing address

116 E 11TH St
Suite 101
Spencer, IA 51301-4364
Phone (712) 264-3500

Other names 1

  • Avera Medical Group Spencer Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000384 IA Part B Supplier - Clinic/Group Practice 0345157103 Receives reassigned benefits from 91 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rock Valley, IA; Spirit Lake, IA; Spencer, IA; Sioux Center, IA; Sibley, IA; Rock Rapids, IA; Milford, IA; Mason City, IA…

Other NPIs on the same Medicare enrollment 25

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

View all 25

National Provider Directory

National Provider Directory

Member of 2

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

Locations

1100 S 10th Ave
Ste 100
Rock Rapids, IA 51246
Phone (712) 472-5300

116 E 11th St
Ste 101
Spencer, IA 51301
Phone (712) 264-3500

801 E Sioux Ave
Minneapolis, MN 55486

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

100 Mac Ln
Pierre, SD 57501
Phone (605) 224-5901

801 E Dakota Ave
Pierre, SD 57501
Phone (605) 224-3100

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

1417 S Cliff Ave
Ste 100
Sioux Falls, SD 57105
Phone (605) 322-7580

2412 S Cliff Ave
Ste 200
Sioux Falls, SD 57105
Phone (605) 322-4079

6701 S Minnesota Ave
Sioux Falls, SD 57108
Phone (605) 322-6960

Practitioners & affiliated clinicians

Practitioners 54

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.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331510400000",
    "number": "1902886567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E 11TH ST",
            "address_2": "SUITE 101",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014364",
            "telephone_number": "712-264-3500",
            "fax_number": "712-264-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E 11TH ST",
            "address_2": "SUITE 101",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014364",
            "telephone_number": "712-264-3500",
            "fax_number": "712-264-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2012-03-12",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "V.P. FINANCE",
        "authorized_official_telephone_number": "605-322-6375",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Spencer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spencer, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.