AVERA MCKENNAN (NPI# 1104892892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104892892 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP NEPHROLOGY SIOUX FALLS |
| Practice Address |
1315 S. Cliff Ave. Ste. 2000 Sioux Falls SD 57105-1058 |
| Mailing Address |
Po Box 86370 Sioux Falls SD 57118-6370 |
| Practice Telephone | 6053225800 |
| Practice Fax Number | 6053225801 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2006-02-23 |
| 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 | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PRIMEWEST | 031013001 | 01 |
| SD | HEALTHPARTNERS | 81741 | 01 |
| ND | 12903 | 05 | |
| SD | DAKOTACARE | 9191250 | 01 |
| SD | BCBS | 0008493 | 01 |
| MN | BLUE PLUS | 118T5NO | 01 |
| MN | 210830500 | 05 | |
| IA | 0550814 | 05 | |
| MN | BCBS | 118T5NO | 01 |
| SD | DEPT OF LABOR | 370624200 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Nephrology Sioux Falls | Doing Business As Name - 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 |
1315 S. CLIFF AVE. STE. 2000 |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-1058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043209760 | Jeffery L Steers | Transplant Surgery | 1315 S. Cliff Ave., Ste. 1100, Sioux Falls, SD 57105-1057 | 2005-10-15 |
| 1164815163 | Ashley J Van Hill | Nurse Practitioner | 1315 S. Cliff Ave., Ste. 1100, Sioux Falls, SD 57105-1057 | 2015-03-15 |
| 1710267950 | Kristine Lynn Houselog | Nurse Practitioner | 1315 S. Cliff Ave., Ste. 1200, Sioux Falls, SD 57105-1057 | 2011-08-19 |
| 1336450543 | Rebekka Klemme | Nurse Practitioner | 1315 S. Cliff Ave., Ste. 1100, Sioux Falls, SD 57105-1057 | 2010-06-23 |
| 1811143233 | Ajaz Ahamad Banka | Internal Medicine | 1315 S. Cliff Ave., Ste. 3000, Sioux Falls, SD 57105-1061 | 2008-08-18 |
| 1740462803 | Raquel De Leon Anel-tiangco | Internal Medicine | 1315 S. Cliff Ave., Ste. 3000, Sioux Falls, SD 57105-1061 | 2007-11-30 |
| 1174716294 | Ali Naji Al-hajjaj | Transplant Surgery | 1315 S. Cliff Ave., Ste. 1100, Sioux Falls, SD 57105-1057 | 2007-08-22 |
| 1396945267 | Avera Mckennan | Internal Medicine | 1315 S. Cliff Ave., Ste. 1200, Sioux Falls, SD 57105-1057 | 2007-07-19 |
| 1134219462 | Victor Leslie James Scott | Anesthesiology | 1315 S. Cliff Ave., Ste. 1100, Sioux Falls, SD 57105-1057 | 2006-10-16 |
| 1164528261 | Richard Swain Crawford | Internal Medicine | 1315 S. Cliff Ave., Ste. 3000, Sioux Falls, SD 57105-1061 | 2006-09-15 |
| Find all providers in the same location | ||||
| 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 | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083671408 | Richard A Jensen | Internal Medicine | 2333 W 57th St Ste 101, Sioux Falls, SD 57108-5054 | 2006-04-28 |
| 1851358600 | Oleg P Georgiev | Internal Medicine | 6709 S. Minnesota Avenue, Suite 101, Sioux Falls, SD 57108-2593 | 2006-04-26 |
| 1962478651 | Robert Nicholas Santella | Internal Medicine | 1315 S Cliff Ave, Ste 2000, Sioux Falls, SD 57105-1058 | 2006-02-23 |
| 1780662437 | Erin L Greer | Internal Medicine | 1315 S Cliff Ave Ste 2000, Sioux Falls, SD 57105-1058 | 2006-01-04 |
| 1417365305 | Faizan Syed | Internal Medicine | 1315 S Cliff Ave Ste 2000, Sioux Falls, SD 57105-1058 | 2014-07-24 |
| 1265680466 | Julie Ann Tan Linatoc | Internal Medicine | 1315 S Cliff Ave, Ste. 2000, Sioux Falls, SD 57105-1058 | 2008-09-03 |
| 1336339357 | Dana Brandys | Internal Medicine | 1205 S. Grange Ave, Ste 201, Sioux Falls, SD 57105-0414 | 2007-07-26 |
| 1629278759 | Lu Y Huber | Internal Medicine | 1315 S Cliff Ave, Ste. 2000, Sioux Falls, SD 57105-1058 | 2007-07-18 |
| 1154524288 | Anthony Jerome Rupp | Internal Medicine | 1205 S Grange Ave, Suite 201, Sioux Falls, SD 57105-0407 | 2007-06-06 |
| 1104035955 | Mohammad Zeeshan Qamar | Internal Medicine | 1205 S Grange Ave, Suite 201, Sioux Falls, SD 57105-0407 | 2007-05-21 |
| Find all providers in SIOUX FALLS | ||||
| 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.