NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera Medical Group Brookings

  • General Practice Physician
  • Brookings, SD
National Provider Identifier
1912936535
Registry record updated Mar 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
AVERA MCKENNAN
Doing business as
Avera Medical Group Brookings
Practice address
400 22ND Ave.
Brookings, SD 57006-2497
Phone
(605) 697-9500
Fax
(605) 697-6939
NPI assigned
Jul 3, 2006
Last updated
Mar 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2011

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

Authorized official

Name
Ms. Julie N Norton
Title
Cfo
Phone
(605) 322-6375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

400 22ND Ave.
Brookings, SD 57006-2497

Mailing address

400 22ND Ave.
Brookings, SD 57006-2497
Phone (605) 697-9500

Other names 1

  • Avera Medical Group Brookings Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000117 SD Part B Supplier - Clinic/Group Practice 0345157103 Receives reassigned benefits from 1,418 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Member of 2

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

Locations

104 W Birch St
Arlington, SD 57212
Phone (605) 983-3283

501 N Sycamore Ave
Sioux Falls, SD 57110
Phone (605) 322-4900

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299715200000",
    "number": "1912936535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 22ND AVE.",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062497",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 22ND AVE.",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062497",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2011-03-10",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-322-6375",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Brookings",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookings, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; 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.