AVERA MCKENNAN (NPI# 1194799882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194799882 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP GASTROENTEROLOGY SIOUX FALLS |
| Practice Address |
6100 S Louise Ave Ste 3100 Sioux Falls SD 57108-6021 |
| Mailing Address |
Po Box 86370 Sioux Falls SD 57118-6370 |
| Practice Telephone | 6055041400 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2019-11-01 |
| 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 | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | PRIMEWEST | 92411422906 | 01 |
| IA | 0530592 | 05 | |
| SD | HEALTHPARTNERS | 65737 | 01 |
| MN | 817930100 | 05 | |
| SD | BCBS | 0006073 | 01 |
| MN | BCBS | 90876BA | 01 |
| SD | DEPT OF LABOR | 370624200 | 01 |
| MN | BLUE PLUS | 90876BA | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Gastroenterology Sioux Falls | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1417 S Cliff Ave, Suite 300, Sioux Falls, SD 571051022 | 6053228630 | 6053228631 |
| 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 |
6100 S LOUISE AVE STE 3100 |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57108-6021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508332842 | Jodi Kay Julius | Nurse Practitioner | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6021 | 2018-10-14 |
| 1124503016 | Amanda Richter | Nurse Practitioner | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6032 | 2018-09-26 |
| 1073929733 | Adam Bledsoe | Internal Medicine | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6032 | 2014-07-02 |
| 1700133667 | Irena Chernatinski | Nurse Practitioner | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6021 | 2012-08-10 |
| 1588829436 | Robert Towner Lapp | Internal Medicine | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6021 | 2008-07-21 |
| 1043423536 | Steven Lloyd Condron | Internal Medicine | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6021 | 2007-05-08 |
| 1750395695 | Erik Ness | Specialist | 6100 S Louise Ave Ste 3100, Sioux Falls, SD 57108-6021 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134735764 | Faith Carlson | Counselor | 5621 S. Southeastern Avenue, Suite 5625, Sioux Falls, SD 57108 | 2020-09-18 |
| 1063020196 | Emily Mensen | Physical Therapist | 4700 W 69th St, Sioux Falls, Sioux Falls, SD 57108 | 2020-07-15 |
| 1528695798 | Allison Mcentee | Physician Assistant | 3620 East Prairiewind Street, Sioux Falls, SD 57108 | 2020-03-26 |
| 1265935829 | Sioux Falls Audiology Associates | Clinic/Center | 4948 E. 57th Street, Sioux Falls, SD 57108 | 2018-03-09 |
| 1184124935 | Haley Elizabeth Luond | Chiropractor | 4900 E 57th Street, Suite B, Sioux Falls, SD 57108 | 2018-02-19 |
| 1770098881 | Yinan Zhao | Acupuncturist | 6001 S Sharon Ave Ste 6, Sioux Falls, SD 57108 | 2017-12-12 |
| 1447780796 | Sioux Falls Specialty Hospital, LLP | Special Hospital | 7600 South Minnesota Ave, Sioux Falls, SD 57108 | 2017-06-19 |
| 1952831786 | Brock T Nelsen | Dentist | 5121 S Solberg Ave #120, Sioux Falls, SD 57108 | 2017-06-14 |
| 1629517552 | Sarah Kenyon | Chiropractor | 6116 S Lyncrest Ave Ste 105, Sioux Falls, SD 57108 | 2017-02-12 |
| 1386029460 | Michelle Anne Pliska | Counselor | 5621 Southeastern Ave, Sioux Falls, SD 57108 | 2015-07-30 |
| Find all providers in zip 57108 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| 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 |
|---|---|---|---|---|
| 1386965580 | Kunut Kijsirichareanchai | Internal Medicine | 1205 S. Grange Avenue, Mb2, Suite 104, Sanford Gastroenterology Clinic, Sioux Falls, SD 57105 | 2010-06-22 |
| 1871792408 | R. D. Meyer, M.d. | Internal Medicine | 1200 S Euclid Ave Ste 210, Sioux Falls, SD 57105-0433 | 2007-07-13 |
| 1518973221 | Sanford Clinic | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2006-08-01 |
| 1235183807 | Chandar Singaram | Internal Medicine | 1905 W 57th St Ste 1, Sioux Falls, SD 57108-2893 | 2006-05-19 |
| 1063486975 | John D Barker Jr. | Internal Medicine | 1001 E. 21st St., Ste. 501, Sioux Falls, SD 57105 | 2006-02-15 |
| 1134191869 | Kozhikode Veetil Narayanan Menon | Internal Medicine | 1001 E 21st St, Suite 303, Sioux Falls, SD 57105-1033 | 2006-02-06 |
| 1295730356 | Tim M Ridgway | Internal Medicine | 1500 W 22nd St, Ste 101, Sioux Falls, SD 57105-1503 | 2005-06-16 |
| 1619972783 | Christopher Michael Hurley | Internal Medicine | 1417 S Cliff Ave, Suite 300, Sioux Falls, SD 57105-1022 | 2005-06-16 |
| 1205831377 | Jorge A Gilbert | Internal Medicine | 1205 S Grange Ave Ste 104, Sioux Falls, SD 57105-0414 | 2005-06-16 |
| 1437564820 | Antonios Wehbeh | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2014-06-25 |
| Find all providers in SIOUX FALLS | ||||
| City | SIOUX FALLS |
| Zip Code | 57108 |
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.