AVERA MCKENNAN (NPI# 1114113693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114113693 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP BRAIN AND SPINE INSTITUTE |
| Practice Address |
1301 S. Cliff Ave. Sioux Falls SD 57105-1032 |
| Mailing Address |
2400 S. Minnesota Ave. Ste. 100 Sioux Falls SD 57105-3762 |
| Practice Telephone | 6053228860 |
| Practice Fax Number | 6053228868 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2007-09-19 |
| 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 | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE PLUS | 46L90AV | 01 |
| SD | BLUE CROSS/SOUTH DAKOTA | 4992512 | 01 |
| SD | DAKOTACARE | 9251037 | 01 |
| SD | HEALTHPARTNERS | 167009 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Brain and Spine Institute | 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 |
1301 S. CLIFF AVE. |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-1032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386610004 | Avera Mckennan | Internal Medicine | 1301 S. Cliff Ave., Ste. 601, Sioux Falls, SD 57105-1032 | 2006-02-23 |
| 1669752358 | Amy Sue Thompson | Nurse Practitioner | 1301 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1023 | 2011-08-25 |
| 1346482890 | Margaret A Carmody | Neurological Surgery | 1301 S. Cliff Ave., Ste. 610, Sioux Falls, SD 57105-1032 | 2009-03-30 |
| 1134195332 | Avera Mckennan | Physical Medicine & Rehabilitation | 1301 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1053 | 2006-02-27 |
| 1912973785 | Fady Ghassan Jamous | Internal Medicine | 1301 S. Cliff Ave., Ste. 601, Sioux Falls, SD 57105-1032 | 2006-02-23 |
| 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 | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871109827 | Wilson T Asfora Md Frcsc PC | Neurological Surgery | 6709 S Minnesota Ave Ste 206a, Sioux Falls, SD 57108-2593 | 2020-09-16 |
| 1033130216 | Eric Robert Trumble | Neurological Surgery | 1210 W 18th St Ste 100, Sioux Falls, SD 57104-4650 | 2006-07-22 |
| 1417921685 | Daniel Gerard Tynan | Neurological Surgery | 1301 S. Cliff Ave, Ste 610, Sioux Falls, SD 57105-1032 | 2006-02-15 |
| 1750355236 | Mark Warren Fox | Neurological Surgery | 1100 E 21st St, Ste 220, Sioux Falls, SD 57105-1020 | 2006-02-14 |
| 1194706754 | Wilson T Asfora Md Frcsc PC | Neurological Surgery | 2601 S Minnesota Avenue, Ste 105 Mb385, Sioux Falls, SD 57105 | 2005-11-10 |
| 1316369523 | Nessim Amin | Neurological Surgery | 1210 W 18th St Ste 100, Sioux Falls, SD 57104-4650 | 2014-01-08 |
| 1861758856 | Shawn Michael Vuong | Neurological Surgery | 1210 W 18th St Ste 100, Sioux Falls, SD 57104-9890 | 2012-04-04 |
| 1346482890 | Margaret A Carmody | Neurological Surgery | 1301 S. Cliff Ave., Ste. 610, Sioux Falls, SD 57105-1032 | 2009-03-30 |
| 1366613473 | Mark W Fox Md PC | Neurological Surgery | 1100 E 21st St, Suite 220, Sioux Falls, SD 57105-1020 | 2008-03-17 |
| 1629257365 | Tuan V Nguyen | Neurological Surgery | 1301 S. Cliff Ave, Ste. 610, Sioux Falls, SD 57105-1032 | 2007-10-30 |
| Find all providers in SIOUX FALLS | ||||
| City | SIOUX FALLS |
| Zip Code | 57105 |
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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.