Active NPI
Avera McKennan
- Clinic/Center
- Spirit Lake, IA
National Provider Identifier
1922196856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- AVERA MCKENNAN
- Practice address
- 2700 23Rd Street
Spirit Lake, IA 51360 - Phone
- (712) 336-2410
- Fax
- (712) 336-3241
- NPI assigned
- Oct 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Julie N Norton
- Title
- Cfo
- Phone
- (605) 322-6375
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
2700 23Rd Street
Spirit Lake, IA 51360
Mailing address
2700 23Rd Street
Spirit Lake, IA 51360
Phone (712) 336-2410
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 146241 | Medicaid | IA |
Other names 1
- Avera Spirit Lake Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1496188800000",
"number": "1922196856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 23RD STREET",
"city": "SPIRIT LAKE",
"state": "IA",
"postal_code": "51360",
"telephone_number": "712-336-2410",
"fax_number": "712-336-3241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 23RD STREET",
"city": "SPIRIT LAKE",
"state": "IA",
"postal_code": "51360",
"telephone_number": "712-336-2410",
"fax_number": "712-336-3241"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVERA MCKENNAN",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-10",
"last_updated": "2017-05-31",
"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"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "146241",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Avera Spirit Lake Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Spirit Lake, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; 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.