AVERA MCKENNAN (NPI# 1073585949) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073585949 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP NEONATOLOGY SIOUX FALLS |
| Practice Address |
1325 S. Cliff Ave. Sioux Falls SD 57105-1007 |
| Mailing Address |
Po Box 86370 Sioux Falls SD 57118-6370 |
| Practice Telephone | 6053224425 |
| Practice Fax Number | 6053224499 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2018-10-24 |
| Authorized Official Name | DAVID FLICEK (CEO/PRESIDENT) |
| Authorized Official Telephone | 6053228000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 065778600 | 05 | |
| SD | HEALTHPARTNERS | 61598 | 01 |
| SD | 6701500 | 05 | |
| IA | 0555367 | 05 | |
| SD | 6701090 | 05 | |
| SD | 6701340 | 05 | |
| SD | BCBS | 4999723 | 01 |
| SD | 6701790 | 05 | |
| SD | DEPT OF LABOR | 370624200 | 01 |
| MN | BLUE PLUS | 7F824MA | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Neonatology Sioux Falls | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154979805 | Avera Mckennan | Substance Abuse Rehabilitation Facility | 6140 S Curae Lane, Sioux Falls, SD 57108-3047 | 2019-08-27 |
| 1205311628 | Avera Mckennan | Pharmacy | 6100 S Louise Ave Ste 1100, Sioux Falls, SD 57108-6021 | 2018-10-02 |
| 1316463219 | Avera Mckennan | Pharmacy | 1200 S. 7th Avenue, Suite 101, Sioux Falls, SD 57105 | 2017-08-22 |
| 1851848444 | Avera Mckennan | Durable Medical Equipment & Medical Supplies | 2100 S Marion Road, Ste 125, Sioux Falls, SD 57106-3645 | 2016-09-01 |
| 1295187417 | Avera Mckennan | Psychiatry & Neurology | 6709 S. Minnesota Ave., Ste. 103, Sioux Falls, SD 57108-2593 | 2016-07-12 |
| 1669871000 | Avera Mckennan | Durable Medical Equipment & Medical Supplies | 3820 N Potsdam Ave Ste 2, Sioux Falls, SD 57104-7057 | 2014-08-21 |
| 1922413806 | Avera Mckennan | Clinic/Center | 400 2nd Ave, Brookings, SD 57006 | 2014-06-30 |
| 1629499132 | Avera Mckennan | Occupational Therapist | 1601 W 44th Pl, Sioux Falls, SD 57105-6376 | 2013-12-31 |
| 1700146396 | Avera Mckennan | Clinic/Center | 1035 South Highline Pl, Ste #4, Sioux Falls, SD 57110 | 2012-05-17 |
| 1467711739 | Avera Mckennan | Pharmacy | 1301 S Cliff Ave Ste 225, Sioux Falls, SD 57105-1068 | 2012-05-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | AVERA MCKENNAN | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 |
| Iowa Business Entities | AVERA MCKENNAN | 1325 S. Cliff St., Sioux Falls, SD 57105 |
| System for Award Management (SAM) Entities | AVERA MCKENNAN HOSPITAL & UNIVERSITY HEALTH CENTER | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 |
| Street Address |
1325 S. CLIFF AVE. |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-1007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104896083 | Jose Marius D Dosado | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| 1053680678 | Avera Mckennan | Radiology | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2011-12-28 |
| 1972837979 | Avera Mckennan | Internal Medicine | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2009-09-23 |
| 1790925311 | Fernando Augusto Soares | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2009-02-22 |
| 1982875803 | Derek J Sitter | Physician Assistant | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2008-03-19 |
| 1225050610 | Michael B. Heisler | Internal Medicine | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-07-24 |
| 1952371825 | Kandi Mcmenamy | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| 1780654665 | Samuel E Rogers | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871117549 | Ashlesha Ravindra Bagwe | Student in an Organized Health Care Education/Training Program | Pediatrics Residency Program, 1305 W 18th St, Rt 6364, Sioux Falls, SD 57105 | 2020-05-29 |
| 1306494489 | Kelsey Elaine Kruse | Counselor | 3101 West 41st, Sioux Falls, SD 57105 | 2019-08-30 |
| 1902388341 | Sarah Tacke | Nurse Practitioner | 1301 West 18th Street, Sioux Falls, SD 57105 | 2018-09-02 |
| 1235624727 | Mahum Shahid | Student in an Organized Health Care Education/Training Program | 1400 W. 22nd St, Sioux Falls, SD 57105 | 2018-06-27 |
| 1942790126 | Smitha Narayana Gowda | Student in an Organized Health Care Education/Training Program | 1400 22nd Street, Sioux Falls, SD 57105 | 2018-05-14 |
| 1326538554 | Mali Elizabeth Teller | Speech-Language Pathologist | 2501 W. 26th Street, Sioux Falls, SD 57105 | 2018-05-14 |
| 1871081505 | Abdelmohaymin Abdalla Abufatima Abdalla | Student in an Organized Health Care Education/Training Program | Usd-ssom-internal Medicine Residency, 1400 22nd Street, Sioux Falls, SD 57105 | 2018-04-27 |
| 1710474697 | Moataz Ellithi | Student in an Organized Health Care Education/Training Program | 1400 W. 22nd St., Sioux Falls, SD 57105 | 2018-04-17 |
| 1366948663 | Holly Ahlers | Registered Nurse | 2000 S. Summit Ave, Sioux Falls, Sd 57105, Sioux Falls, SD 57105 | 2018-04-04 |
| 1558864124 | Darcy Lee Jensen | Counselor | 822 East 41st. Street, Suite 235, Souix Falls, SD 57105 | 2018-03-09 |
| Find all providers in zip 57105 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| 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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104896083 | Jose Marius D Dosado | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| 1548737018 | Jacqueline Deborah Weidauer | Pediatrics | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2018-11-01 |
| 1285054858 | Taylor Hansen | Pediatrics | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 | 2014-04-22 |
| 1487099289 | Kathryn Marie Anderson | Pediatrics | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2013-05-07 |
| 1790925311 | Fernando Augusto Soares | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2009-02-22 |
| 1841471521 | Sanford Medical Center | Pediatrics | 1305 W 18th St, Sioux Falls, SD 57105-0401 | 2007-11-21 |
| 1427258318 | Maria Margarita Talavera Barber | Pediatrics | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 | 2007-07-19 |
| 1952371825 | Kandi Mcmenamy | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| 1780654665 | Samuel E Rogers | Pediatrics | 1325 S. Cliff Ave., Sioux Falls, SD 57105-1007 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205321494 | B&b Neonatology | Pediatrics | 3213 W Main St Ste 128, Rapid City, SD 57702-2314 | 2018-06-29 |
| 1881917078 | Kimberly Sierra Balay | Pediatrics | 4140 Penrose Pl, Rapid City, SD 57702-6828 | 2010-03-02 |
| 1639229727 | Black Hills Pediatrics and Neonatology | Pediatrics | 2905 5th St, Rapid City, SD 57701-7316 | 2007-01-11 |
| 1063437085 | Stephen M Kovarik | Pediatrics | 2905 5th St, Rapid City, SD 57701-7316 | 2006-07-12 |
| 1346265394 | Steven I Benn | Pediatrics | 2905 5th St, Rapid City, SD 57701-7316 | 2006-07-12 |
| City | SIOUX FALLS |
| Zip Code | 57105 |
Please comment or provide details below to improve the information on AVERA MCKENNAN.
| 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.