AVERA QUEEN OF PEACE (NPI# 1053827634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053827634 |
| Entity Type | Organization |
| Organization Name | AVERA QUEEN OF PEACE |
| Other Organization Name | AVERA MEDICAL GROUP RADIOLOGY MITCHELL |
| Practice Address |
525 N Foster St Mitchell SD 57301-2966 |
| Mailing Address |
Po Box 432 Mitchell SD 57301-0432 |
| Practice Telephone | 6059956337 |
| Practice Fax Number | 6059955779 |
| Mailing Telephone | 6059957000 |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2020-08-20 |
| Authorized Official Name | DOUGLAS EKEREN (PRESIDENT/CEO) |
| Authorized Official Telephone | 6056688322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | MEDICARE | S1639 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Radiology Mitchell | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568986040 | Avera Queen of Peace | Internal Medicine | 605 N Foster St Ste 100, Mitchell, SD 57301-2902 | 2017-07-27 |
| 1689051682 | Avera Queen of Peace | Clinic/Center | 409 S Ohlman St, Mitchell, SD 57301-3106 | 2015-04-29 |
| 1649577297 | Avera Queen of Peace | Clinic/Center | 1900 Grassland Dr., Mitchell, SD 57301-6205 | 2011-02-17 |
| 1053557967 | Avera Queen of Peace | Physician Assistant | 115 Second St Se, De Smet, SD 57231-0463 | 2008-12-23 |
| 1699972422 | Avera Queen of Peace | Specialist | 625 N Foster St Ste 200, Mitchell, SD 57301-2968 | 2007-06-27 |
| 1992712921 | Avera Queen of Peace | Pharmacy | 609 1st St Ne, Wessington Springs, SD 57382-2136 | 2006-08-02 |
| 1932105046 | Avera Queen of Peace | Clinic/Center | 265 Main Street, Corsica, SD 57328 | 2005-06-23 |
| 1326043092 | Avera Queen of Peace | Clinic/Center | 213 South Main, Howard, SD 57349 | 2005-06-17 |
| 1316942204 | Avera Queen of Peace | Clinic/Center | 604 1st St Ne, Wessington Springs, SD 57382-2134 | 2005-06-16 |
| 1639174568 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2005-06-16 |
| Street Address |
525 N FOSTER ST |
| City | MITCHELL |
| State | SD |
| Zip Code | 57301-2966 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154324507 | Avera Queen of Peace | Emergency Medicine | 525 N Foster St, Mitchell, SD 57301-2966 | 2005-05-31 |
| 1831752393 | Avera Queen of Peace | Preventive Medicine | 525 N Foster St, Mitchell, SD 57301-2966 | 2019-04-19 |
| 1609358035 | Rachel Dykstra | Nurse Practitioner | 525 N Foster St, Mitchell, SD 57301-2999 | 2018-09-01 |
| 1598241820 | Sarah Lynne Bauer | Nurse Practitioner | 525 N Foster St, Mitchell, SD 57301-2999 | 2018-07-19 |
| 1821504515 | Mollie Jo Loes | Dietitian, Registered | 525 N Foster St, Mitchell, SD 57301-2966 | 2017-12-18 |
| 1669987137 | Karen Faye Klinkner | Dietitian, Registered | 525 N Foster St, Mitchell, SD 57301-2966 | 2017-12-06 |
| 1295240786 | Katherine Caroline Thomsen | Dietitian, Registered | 525 N Foster St, Mitchell, SD 57301-2966 | 2017-12-06 |
| 1205359031 | Avera Queen of Peace | Hospitalist | 525 N Foster St, Mitchell, SD 57301-2966 | 2017-07-24 |
| 1669822946 | Jenna Bortnem | Physical Therapist | 525 N Foster St, Mitchell, SD 57301-2966 | 2016-06-16 |
| 1356799316 | Avera Home Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 525 N Foster St, Mitchell, SD 57301-2966 | 2016-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932721388 | Dakota Counseling Institute | Social Worker | 910 W Havens, Mitchell, SD 57301 | 2020-05-08 |
| 1215588512 | Carolyn Marie Klinkhammer | Registered Nurse | 525 North Foster - Avera Queen of Peace Hospital, Mitchell, SD 57301 | 2019-09-27 |
| 1720596893 | Brian Bannwarth | Pharmacist | 25147 Campground Road, Mitchell, SD 57301 | 2018-01-11 |
| 1336664135 | Haley Long | Speech-Language Pathologist | 200 East Havens, Mitchell, SD 57301 | 2017-08-14 |
| 1770004996 | Edgewood Mitchell LLC | Assisted Living Facility | 501 East Spruce Street, Mitchell, SD 57301 | 2017-06-28 |
| 1467831685 | Amanda Louise Johnson | Physical Therapist | 910 S Edgerton, Mitchell, SD 57301 | 2015-05-20 |
| 1922432830 | Melissa Jill Maier | Dentist | 240 E 23 Ave, Mitchell, SD 57301 | 2013-08-27 |
| 1356626972 | Lewis Family Drug, LLC | Pharmacy | 1507 N Main St, Mitchell, SD 57301 | 2011-10-14 |
| 1184945958 | Kimberly L Lienemann | Counselor | 403 N Lawler St, Mitchell, SD 57301 | 2010-06-16 |
| 1134365554 | Gronsten-maier Dental Prof. LLC | Dentist | 240 E. 23rd Avenue, Mitchell, SD 57301 | 2009-01-07 |
| Find all providers in zip 57301 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114085693 | Tamara Sue Wheeler | Radiology | 2200 N Kimball # 700, Mitchell, SD 57301 | 2006-12-05 |
| 1780751099 | Kelly Don Smith | Radiology | 2200 N Kimball #700, Mitchell, SD 57301 | 2006-11-29 |
| 1942333208 | Calvin F Andersen | Radiology | 2200 N Kimball, #700, Mitchell, SD 57301 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720421381 | Jamie Catherine Williams | Radiology | 1309 W 17th St Ste G01, Sioux Falls, SD 57104-4663 | 2013-04-14 |
| 1518284223 | Neil Kumar | Radiology | 2929 5th St Ste 230, Rapid City, SD 57701-7338 | 2010-04-21 |
| 1952535536 | Sacred Heart Health Services | Radiology | 501 Summit St Ste 8, Yankton, SD 57078-3855 | 2009-05-11 |
| 1841430162 | Martin Frank Petereit | Radiology | 1600 E. Cedar Lane, Retired Radiologist, Sioux Falls, SD 57103 | 2009-02-26 |
| 1558510586 | Diagnostic Radiology Services, Prof, LLC | Radiology | 2212 Valley Rd, Yankton, SD 57078-1895 | 2008-09-15 |
| 1629267224 | Clark L Carrol | Radiology | Box 1020665, Sioux Falls, SD 57186-0001 | 2007-10-18 |
| 1861685166 | Sanford Clinic | Radiology | 891 14th Ave Ne, Watertown, SD 57201 | 2007-08-21 |
| 1194865394 | Midwest Regional Imaging Services LLC | Radiology | 6001 S Sharon, Suite 2, Sioux Falls, SD 57108 | 2007-02-07 |
| 1245250356 | Christopher K Johansen | Radiology | 1210 W 18th St Ste Ll03, Sioux Falls, SD 57104 | 2006-07-20 |
| 1174548937 | Avera St Lukes | Radiology | 1400 10th Ave W, Mobridge, SD 57601-1246 | 2006-07-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.