AVERA MCKENNAN (NPI# 1205808748) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205808748 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP MATERNAL FETAL MEDICINE SIOUX FALLS |
| Practice Address |
1417 S. Cliff Ave. Ste. 100 Sioux Falls SD 57105-1063 |
| Mailing Address |
Po Box 86370 Sioux Falls SD 57118-6370 |
| Practice Telephone | 6053228937 |
| Practice Fax Number | 6053228938 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2006-02-07 |
| 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 | 207VM0101X |
Obstetrics & Gynecology Specialization: Maternal & Fetal Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 482413000 | 05 | |
| MN | BCBS | 361ROPE | 01 |
| IA | 0573360 | 05 | |
| SD | PRIMEWEST | 924114229808 | 01 |
| NE | 10025040700 | 05 | |
| SD | BCBS | 4994376 | 01 |
| SD | DAKOTACARE | 9216740 | 01 |
| SD | HEALTHPARTNERS | 95736 | 01 |
| MN | BLUE PLUS | 361R1WA | 01 |
| SD | DEPT OF LABOR | 370624200 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Maternal Fetal Medicine 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 |
1417 S. CLIFF AVE. STE. 100 |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-1063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952308397 | Courtney-maree Heynen | Advanced Practice Midwife | 1417 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1064 | 2005-06-30 |
| 1932566379 | Brenna Davis | Physician Assistant | 1417 S. Cliff Ave., Ste. 010, Sioux Falls, SD 57105-1014 | 2016-01-15 |
| 1184976979 | Amy St Aubin | Nurse Practitioner | 1417 S. Cliff Ave., Suite 401, Sioux Falls, SD 57105-1064 | 2012-10-04 |
| 1518228626 | Catherine Marie Brockmeier | Obstetrics & Gynecology | 1417 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1064 | 2012-06-05 |
| 1427321496 | Audra Joy Degroot | Midwife | 1417 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1064 | 2012-02-21 |
| 1053682997 | Jodie Katherine Hartmann Mcsherry | Physician Assistant | 1417 S. Cliff Ave., Ste. 300, Sioux Falls, SD 57105-1062 | 2012-01-24 |
| 1013215672 | Kaitlin M Feehan | Physician Assistant | 1417 S. Cliff Ave., Ste 010, Sioux Falls, SD 57105-1014 | 2011-03-07 |
| 1194036590 | Amanda Lee Kappenman | Obstetrics & Gynecology | 1417 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1064 | 2010-06-30 |
| 1760604573 | Molly Jo Uhing | Obstetrics & Gynecology | 1417 S. Cliff Ave., Ste 401, Sioux Falls, SD 57105-1064 | 2007-05-02 |
| 1871514299 | Kimberlee Ann Mckay | Obstetrics & Gynecology | 1417 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1064 | 2006-07-21 |
| 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 | 207VM0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Maternal & Fetal Medicine |
| An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760739510 | Oscar Andres Viteri Molina | Obstetrics & Gynecology | 1417 S Cliff Ave Ste 100, Sioux Falls, SD 57105 | 2012-08-11 |
| 1639240732 | Leslie N. Heddleston | Obstetrics & Gynecology | 1417 S Cliff Ave, Ste 100, Sioux Falls, SD 57105-1063 | 2006-11-11 |
| 1972575843 | Michael Mcnamara | Obstetrics & Gynecology | 1500 W 22nd St, Ste 401, Sioux Falls, SD 57105-7702 | 2006-02-06 |
| 1841296696 | Jeffrey G Boyle | Obstetrics & Gynecology | 1500 W 22nd St, Ste 401, Sioux Falls, SD 57105-1503 | 2005-06-27 |
| 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.