Avera McKennan

Primary specialty

PharmacyTaxonomy code 333600000X

License

4574 Issued in IA

Legal business name

AVERA MCKENNAN

Doing business as

Avera 69th Street Pharmacy

Practice address

4400 W 69TH St Ste 300
Sioux Falls, SD 57108-8170

Phone

(605) 322-5948

Fax

(605) 322-5949

NPI assigned

Oct 17, 2011

Last updated

Jul 19, 2018By 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

Darrel Mutchler, PHARMDNPI 1255000709

Title

Retail Pharmacy Manager

Phone

(605) 322-8331

Specialties & licenses 5

Addresses

Other identifiers 4

Other names 1

• Avera 69th Street Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in SD2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 6

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

• Avera McKennan

  dba Avera on Louise Pharmacy

  • Pharmacy
  • Sioux Falls, SD
  • NPI 1205311628

  O20081124000161

  Same enrollment
• Avera McKennan

  dba Avera 7th Avenue Pharmacy

  • Community/Retail Pharmacy
  • Sioux Falls, SD
  • NPI 1316463219

  O20081124000161

  Same enrollment
• Avera McKennan

  dba Avera Specialty Pharmacy

  • Specialty Pharmacy
  • Sioux Falls, SD
  • NPI 1346266202

  O20081124000161

  Same enrollment
• Avera McKennan

  dba Avera Long Term Care Pharmacy

  • Long Term Care Pharmacy
  • Sioux Falls, SD
  • NPI 1669871000

  O20081124000161

  Same enrollment
• Avera McKennan

  dba Avera Long Term Care Pharmacy Aberdeen

  • Long Term Care Pharmacy
  • Aberdeen, SD
  • NPI 1841948643

  O20081124000161

  Same enrollment
• Avera McKennan

  dba Avera Plaza 2 Pharmacy

  • Pharmacy
  • Sioux Falls, SD
  • NPI 1861110876

  O20081124000161

  Same enrollment

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

Medicare medical equipment & supply locations

Tax ID family

Presentation Health Sys105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

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

• 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
• Avera McKennan

  dba Avera McKennan Regional Lab

  • Clinical Medical Laboratory
  • Sioux Falls, SD
  • NPI 1891718136
  NPD tax ID
• Avera McKennan

  dba Avera Community Health Resource Program

  • Community Health Worker
  • Sioux Falls, SD
  • NPI 1902525983
  NPD tax ID
• Avera McKennan

  dba Avera Adolescent Addiction Center

  • Children's Substance Abuse Rehabilitation Facility
  • Sioux Falls, SD
  • NPI 1902559271
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group McGreevy Washington School

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1912153578
  NPD tax ID
• Avera McKennan

  dba Avera Hand County Memorial Hospital

  • Critical Access Hospital
  • Miller, SD
  • NPI 1922277060
  NPD tax ID
• Avera McKennan

  • Urgent Care Clinic/Center
  • Brookings, SD
  • NPI 1922413806
  NPD tax ID
• Avera McKennan

  • Home Health Agency
  • Flandreau, SD
  • NPI 1932319589
  NPD tax ID
• Avera McKennan

  dba Avera Medical Group Gynecologic Oncology Sioux Falls

  • Gynecologic Oncology Physician
  • Sioux Falls, SD
  • NPI 1932346251
  NPD tax ID
• Avera McKennan

  dba Avera Rosebud Country Care Center

  • Skilled Nursing Facility
  • Gregory, SD
  • NPI 1952330706
  NPD tax ID
• Avera McKennan

  dba Avera Dialysis Milbank

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Milbank, SD
  • NPI 1952841629
  NPD tax ID

Member of 2

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

• Avera Home Medical Equipment, LLC

  • Durable Medical Equipment & Medical Supplies
  • Parkston, SD
  • NPI 1568530566

  Member Of

  NPD member
• Avera Home Medical Equipment, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pierre, SD
  • NPI 1669548616

  Member Of

  NPD member

Locations

All facility ownership & control disclosures 9

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

Practitioners 2

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.

• Darrel Mutchler, PHARMD

  • Pharmacist
  • Sioux Falls, SD
  • NPI 1255000709
  Authorized official Same address or phone
• Amanda Noel Funke Plaetz

  • Pharmacist
  • Sioux Falls, SD
  • NPI 1518539345
  NPD (past)

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1962787440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 W 69TH ST STE 300",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088170",
            "telephone_number": "605-322-5948",
            "fax_number": "605-322-5949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W 69TH ST STE 300",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088170",
            "telephone_number": "605-322-5948",
            "fax_number": "605-322-5949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-17",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "MUTCHLER",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "RETAIL PHARMACY MANAGER",
        "authorized_official_telephone_number": "605-322-8331",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IA",
            "license": "4574",
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "SD",
            "license": "100-1967",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NE",
            "license": "1020",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.019698",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "MN",
            "license": "264333",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962787440",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962787440",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132318",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962787440",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera 69th Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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)
• Avera McKennan (Avera Medical Group Intensivists Sioux Falls)
• Avera McKennan Hospital and Health System
• Avera McKennan Hospital Medical Staff
• William H. Avery, DO
• Mohammed T T Awad, MD

• Pharmacy in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Pharmacy in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; 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.