AVERA MCKENNAN (NPI# 1700062213) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700062213 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP WORTHINGTON |
| Practice Address |
1216 Ryans Rd Worthington MN 56187-1722 |
| Practice Telephone | 5073722921 |
| Practice Fax Number | 5073725789 |
| Mailing Telephone | 5073722921 |
| Mailing Fax Number | 5073725789 |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2013-04-01 |
| Authorized Official Name | KELLI VAN GROUW (CLINIC MANAGER) |
| Authorized Official Telephone | 5073722921 |
| Is Organization Subpart | Y |
| Parent Organization Name | AVERA MCKENNAN |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | RAILROAD MEDICARE | 690009299 | 01 |
| MN | BCBS | 48941WO | 01 |
| MN | 951015000 | 05 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Worthington | 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 |
1216 RYANS RD |
| City | WORTHINGTON |
| State | MN |
| Zip Code | 56187-1722 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306839022 | Benjamin Ernest Gaines | Obstetrics & Gynecology | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2005-08-28 |
| 1891335311 | Efrain Ocegueda | Dietitian, Registered | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2020-01-13 |
| 1629632443 | Debra Kay Behrends | Registered Nurse | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2019-04-26 |
| 1730563404 | Amir Makhmalbaf | Internal Medicine | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2015-07-13 |
| 1629472964 | Victoria Blanchette | Nurse Practitioner | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2014-10-15 |
| 1801226188 | Kristal Grigsby | Social Worker | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2013-11-22 |
| 1679826465 | Darlene Renee Dewitt | Dietitian, Registered | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2012-10-18 |
| 1922357839 | Avera Mckennan | Clinic/Center | 1216 Ryans Rd, Suite 2, Worthington, MN 56187-1722 | 2012-09-06 |
| 1609135367 | Katherine Elizabeth Smidt | Advanced Practice Midwife | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2012-05-15 |
| 1821319344 | Syed Asad Shah | Family Medicine | 1216 Ryans Rd, Worthington, MN 56187-1722 | 2010-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316224363 | Paul Michael Carlson | Dentist | 507 South Shore Drive, Worthington, MN 56187 | 2011-11-04 |
| 1912216540 | Nobles County Jail | Clinic/Center | 1530 Airport Road, Worthington, MN 56187 | 2010-09-30 |
| 1306984539 | Edward Thomas Mcniece | Dentist | 1027 Second Ave, Worthington, MN 56187 | 2007-02-01 |
| 1053338780 | Diagnostic Radiologic Imaging Pa | Radiology | 1607 N Mcmillan St, Ste 1, Worthington, MN 56187 | 2006-07-17 |
| 1427014232 | Scott James Hoffman | Podiatrist | 1205 Ryans Road, Worthington, MN 56187 | 2006-04-21 |
| 1588654404 | Jason Coy Turner | Pharmacist | 511 10th St, Worthington, MN 56187 | 2005-10-22 |
| 1518433879 | Nicole Block | Nurse Practitioner | 1680 Diagonal Rd, Worthington, MN 56187 | 2018-10-15 |
| 1033423322 | Rachael R Dekker | Nurse Practitioner | 1018 6th Ave, Worthington, MN 56187 | 2010-07-29 |
| 1417196601 | Jonathan Gabriel Eli-phillips | Obstetrics & Gynecology | 1018 6th Ave, Worthington, MN 56187 | 2009-02-11 |
| 1174716245 | Sanford Clinic | Radiology | 1018 6th Ave, Worthington, MN 56187 | 2007-08-22 |
| Find all providers in zip 56187 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699279521 | University Sleep Medicine LLC | Clinical Medical Laboratory | 885 High St Ste 107, Worthington, OH 43085-4158 | 2018-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831799691 | Jke Enterprises LLC | Clinical Medical Laboratory | 14690 Galaxie Ave Ste 110, Apple Valley, MN 55124-8522 | 2020-10-29 |
| 1720685332 | Kahlert Companies, Inc. | Clinical Medical Laboratory | 7685 Parklawn Ave Ste 200, Edina, MN 55435-5152 | 2020-10-06 |
| 1932722535 | Infectolab Americas | Clinical Medical Laboratory | 3510 Hopkins Pl N, Oakdale, MN 55128-7578 | 2020-05-19 |
| 1821610148 | Algos Laboratories, LLC | Clinical Medical Laboratory | 111 Hundertmark Rd Ste 470, Chaska, MN 55318-1461 | 2020-05-08 |
| 1043848112 | Kingdom Pathways | Clinical Medical Laboratory | 426 Oxford St N, Saint Paul, MN 55104-5080 | 2020-04-01 |
| 1255995890 | Bunka Enterprise L.L.C. | Clinical Medical Laboratory | 701 Decatur Ave N Ste 101, Golden Valley, MN 55427-4363 | 2019-04-29 |
| 1578030839 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 380 W County Road D, Saint Paul, MN 55112-3501 | 2018-10-25 |
| 1851805915 | Quest Diagnostics LLC Il | Clinical Medical Laboratory | 11091 Ulysses St Ne Ste 100, Blaine, MN 55434-4238 | 2017-11-28 |
| 1588178602 | Quest Diagnostics LLC Il | Clinical Medical Laboratory | 8515 Eagle Point Blvd Ste 100, Lake Elmo, MN 55042-8624 | 2017-11-28 |
| 1194241166 | Five Stars Recovery Center | Clinical Medical Laboratory | 1045 Stoughton Ave., Chaska, MN 55318 | 2017-08-21 |
| Find all providers with the same taxonomy | ||||
| City | WORTHINGTON |
| Zip Code | 56187 |
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.