AVERA MCKENNAN (NPI# 1285701870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285701870 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP MCGREEVY BRANDON |
| Practice Address |
1101 E Holly Blvd Brandon SD 57005-1426 |
| Mailing Address |
Po Box 86430 Sioux Falls SD 57118-6430 |
| Practice Telephone | 6055823853 |
| Practice Fax Number | 6055823855 |
| Mailing Telephone | 6053224900 |
| Mailing Fax Number | 6053224910 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-05-10 |
| Authorized Official Name | JULIE N NORTON (SR VICE PRESIDENT OF FINANCE) |
| Authorized Official Telephone | 6053227818 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0716829 | 05 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group McGreevy Brandon | 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 |
1101 E HOLLY BLVD |
| City | BRANDON |
| State | SD |
| Zip Code | 57005-1426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396780698 | Barbara Harvison | Physician Assistant | 1101 E Holly Blvd, Brandon, SD 57005 | 2006-06-19 |
| 1598273542 | Ann J Bossman | Nurse Practitioner | 1101 E Holly Blvd, Brandon, SD 57005-1426 | 2018-01-11 |
| 1437507399 | Samuel Max Zollicker | Family Medicine | 1101 E Holly Blvd, Brandon, SD 57005-1426 | 2016-06-01 |
| 1316974959 | Darren Chester | Family Medicine | 1101 E Holly Blvd, Brandon, SD 57005-1426 | 2006-06-27 |
| 1003843624 | Richard Briggs | Family Medicine | 1101 E Holly Blvd, Brandon, SD 57005-1426 | 2006-06-27 |
| 1205871480 | Michelle Mcelroy | Family Medicine | 1101 E Holly Blvd, Brandon, SD 57005-1426 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144794926 | Sarah Hewitt | Counselor | 316 E Holly Blvd, Brandon, SD 57005 | 2019-01-15 |
| 1790175388 | Cody Lee Kruckenberg | Chiropractor | 312 E Holly Blvd, Brandon, SD 57005 | 2015-02-03 |
| 1356577159 | Matthew Krivarchka | Dentist | 1511 W. Holly Boulevard, Brandon, SD 57005 | 2009-06-08 |
| 1851546253 | Karla Karrin Jorgenson | Occupational Therapist | 103 North Splitrock Blvd, Brandon, SD 57005 | 2008-11-26 |
| 1598954364 | David Fitzgerald Ward Dc | Chiropractor | 1302 E Rushmore, Brandon, SD 57005 | 2007-10-17 |
| 1477675437 | Kara Lynn Baas | Counselor | 1320 E Rushmore Drive, Suite 107, Brandon, SD 57005 | 2007-04-03 |
| 1124161773 | Michael R Juba | Dentist | 704 N Splitrock Blvd, Brandon, SD 57005 | 2007-02-14 |
| 1548334246 | Med Star Paramedic Inc | Non-emergency Medical Transport (VAN) | 922 E Redwood Blvd, Brandon, SD 57005 | 2006-11-17 |
| 1386723468 | Prairie Rehabilitation Services, Inc. | Durable Medical Equipment & Medical Supplies | 1220 E. Holly Blvd, Brandon, SD 57005 | 2006-11-02 |
| 1326121807 | David Fitzgerald Ward | Chiropractor | 1302 E Rushmore Dr, Brandon, SD 57005-0408 | 2006-10-20 |
| Find all providers in zip 57005 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900581 | Maegan Cook Bridges | Family Medicine | 312 Ridge Pointe Dr, Brandon, MS 39042-5035 | 2020-10-24 |
| 1346887353 | Kelli Marie Foster | Family Medicine | 515 Belle Oak Pl, Brandon, MS 39042-8111 | 2019-12-09 |
| 1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
| 1033566161 | Medi Brandon LLC | Family Medicine | 203 W Bloomingdale Ave, Brandon, FL 33511-7404 | 2016-05-18 |
| 1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
| 1457780637 | Jennifer Packing-ebuen | Family Medicine | 426w Brandon Blvd, Brandon, FL 33511-5002 | 2013-11-07 |
| 1548698608 | St Dominic Medical Associates LLC | Family Medicine | 1297 West Government Street, Brandon, MS 39042 | 2013-10-28 |
| 1265780910 | Uc1, LLC | Family Medicine | 799 Lumsden Rd, Brandon, FL 33511 | 2012-08-28 |
| 1992082721 | Mathew Medical Consulting Pa | Family Medicine | 635 Tuscanny St, Brandon, FL 33511-6165 | 2011-11-08 |
| 1003192246 | Sandra Dorsey | Family Medicine | 122 South Moon Avenue, Brandon, FL 33511 | 2011-11-02 |
| Find all providers in BRANDON | ||||
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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.