Avera McKennan

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

AVERA MCKENNAN

Doing business as

Avera Medical Group Worthington Surgery Center

Practice address

1216 Ryans Rd
Suite 2
Worthington, MN 56187-1722

Phone

(507) 372-2921

Fax

(507) 372-5789

NPI assigned

Sep 6, 2012

Organization subpart

Yes

Parent organization

AVERA MCKENNANAs reported in NPPES

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

Authorized official

Name

Kelli Vangrouw

Title

Clinic Manager

Phone

(507) 372-2921

Specialties & licenses 1

Addresses

Other names 1

• Avera Medical Group Worthington Surgery Center Doing business as

Part of

Avera McKennan Hosp

Locations

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1922357839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 RYANS RD",
            "address_2": "SUITE 2",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871722",
            "telephone_number": "507-372-2921",
            "fax_number": "507-372-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 RYANS RD",
            "address_2": "SUITE 2",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871722",
            "telephone_number": "507-372-2921",
            "fax_number": "507-372-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA MCKENNAN",
        "enumeration_date": "2012-09-06",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "VANGROUW",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "507-372-2921"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Worthington Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Avera McKennan (Avera Medical Group Optometry Worthington)
• Avera McKennan (Avera Medical Group Worthington)
• Avera McKennan (Avera Medical Group Lakefield)
• Avera McKennan (Avera Medical Group Worthington)
• Avera McKennan (Avera Medical Group Heron Lake)
• Naomi Noelle Bach
• Heather Lanae Bajema, PSY.D.
• Bassel Bardan, MD
• Maria Del Rosario Barrera
• Karl W Beesch, MD

• Ambulatory Surgical Clinic/Center in Worthington, MN
• Providers in Worthington, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.