AVERA QUEEN OF PEACE (NPI# 1881049484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881049484 |
| Entity Type | Organization |
| Organization Name | AVERA QUEEN OF PEACE |
| Other Organization Name | AVERA MEDICAL GROUP DERMATOLOGY MITCHELL |
| Practice Address |
1900 Grassland Dr Mitchell SD 57301-6205 |
| Mailing Address |
Po Box 432 Mitchell SD 57301-0432 |
| Practice Telephone | 6059957000 |
| Practice Fax Number | 6059957018 |
| Mailing Telephone | 6059957000 |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2020-08-20 |
| Authorized Official Name | DOUGLAS EKEREN (PRESIDENT/CEO) |
| Authorized Official Telephone | 6056688322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | MEDICARE PTAN | S1639 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Dermatology Mitchell | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568986040 | Avera Queen of Peace | Internal Medicine | 605 N Foster St Ste 100, Mitchell, SD 57301-2902 | 2017-07-27 |
| 1689051682 | Avera Queen of Peace | Clinic/Center | 409 S Ohlman St, Mitchell, SD 57301-3106 | 2015-04-29 |
| 1649577297 | Avera Queen of Peace | Clinic/Center | 1900 Grassland Dr., Mitchell, SD 57301-6205 | 2011-02-17 |
| 1053557967 | Avera Queen of Peace | Physician Assistant | 115 Second St Se, De Smet, SD 57231-0463 | 2008-12-23 |
| 1699972422 | Avera Queen of Peace | Specialist | 625 N Foster St Ste 200, Mitchell, SD 57301-2968 | 2007-06-27 |
| 1992712921 | Avera Queen of Peace | Pharmacy | 609 1st St Ne, Wessington Springs, SD 57382-2136 | 2006-08-02 |
| 1932105046 | Avera Queen of Peace | Clinic/Center | 265 Main Street, Corsica, SD 57328 | 2005-06-23 |
| 1326043092 | Avera Queen of Peace | Clinic/Center | 213 South Main, Howard, SD 57349 | 2005-06-17 |
| 1316942204 | Avera Queen of Peace | Clinic/Center | 604 1st St Ne, Wessington Springs, SD 57382-2134 | 2005-06-16 |
| 1639174568 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2005-06-16 |
| Street Address |
1900 GRASSLAND DR |
| City | MITCHELL |
| State | SD |
| Zip Code | 57301-6205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306943576 | Xenofon Papadopoulos | Urology | 1900 Grassland Dr, Mitchell, SD 57301-6335 | 2006-09-20 |
| 1952911877 | Nancy Jo Miller | Dietitian, Registered | 1900 Grassland Dr, Mitchell, SD 57301-6335 | 2020-08-05 |
| 1669027678 | Rural Health Care, Inc | Family Medicine | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2019-08-06 |
| 1033762984 | Theresa Miiller | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2019-07-19 |
| 1649831637 | Maggie Riggs | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2019-06-21 |
| 1154896801 | Angela Mae Broughton | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2018-10-09 |
| 1417495649 | Laura Axsom | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2017-02-08 |
| 1710359252 | Avera Queen of Peace | Pharmacy | 1900 Grassland Dr, Ste 101, Mitchell, SD 57301 | 2015-10-23 |
| 1780055780 | Lacey Bonte | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2015-10-15 |
| 1972981330 | Thad Kandel | Surgery | 1900 Grassland Dr, Mitchell, SD 57301-6335 | 2015-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932721388 | Dakota Counseling Institute | Social Worker | 910 W Havens, Mitchell, SD 57301 | 2020-05-08 |
| 1215588512 | Carolyn Marie Klinkhammer | Registered Nurse | 525 North Foster - Avera Queen of Peace Hospital, Mitchell, SD 57301 | 2019-09-27 |
| 1720596893 | Brian Bannwarth | Pharmacist | 25147 Campground Road, Mitchell, SD 57301 | 2018-01-11 |
| 1336664135 | Haley Long | Speech-Language Pathologist | 200 East Havens, Mitchell, SD 57301 | 2017-08-14 |
| 1770004996 | Edgewood Mitchell LLC | Assisted Living Facility | 501 East Spruce Street, Mitchell, SD 57301 | 2017-06-28 |
| 1467831685 | Amanda Louise Johnson | Physical Therapist | 910 S Edgerton, Mitchell, SD 57301 | 2015-05-20 |
| 1922432830 | Melissa Jill Maier | Dentist | 240 E 23 Ave, Mitchell, SD 57301 | 2013-08-27 |
| 1356626972 | Lewis Family Drug, LLC | Pharmacy | 1507 N Main St, Mitchell, SD 57301 | 2011-10-14 |
| 1184945958 | Kimberly L Lienemann | Counselor | 403 N Lawler St, Mitchell, SD 57301 | 2010-06-16 |
| 1134365554 | Gronsten-maier Dental Prof. LLC | Dentist | 240 E. 23rd Avenue, Mitchell, SD 57301 | 2009-01-07 |
| Find all providers in zip 57301 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679830905 | Mandi Greenway | Dermatology | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2012-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720441496 | Kathleen Engeln | Dermatology | 105 S State St # 202, Aberdeen, SD 57401-4501 | 2016-03-31 |
| 1003234832 | Katherine Bonnichsen | Dermatology | Avera Medical Group Pierre - Helmsley Center, 801 E Sioux Ave, Pierre, SD 57501 | 2014-03-29 |
| 1972790160 | Christopher Gasbarre | Dermatology | 550 East Colorado Blvd, Spearfish, SD 57783-2776 | 2007-10-02 |
| 1124210828 | Linda Jo Fromm | Dermatology | 4447 S Canyon Rd Ste 6, Rapid City, SD 57702-1889 | 2007-08-16 |
| 1992996771 | Valerie Flynn | Dermatology | 6701 S. Minnesota Ave, Sioux Falls, SD 57108-2591 | 2007-08-06 |
| 1558373845 | Rapid City Medical Center LLP | Dermatology | 130 N 15th St, Hot Springs, SD 57747-1316 | 2006-08-13 |
| 1215981907 | Ian Andrew Whitcroft | Dermatology | 200 E Highland Blvd, Watertown, SD 57201 | 2006-05-19 |
| 1346216074 | Avera Mckennan | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2006-02-23 |
| 1669448387 | Dennis D Knutson | Dermatology | 116 W. 69th St., Ste. 100, Sioux Falls, SD 57108 | 2006-02-23 |
| 1235103060 | Marc E Boddicker | Dermatology | 710 Saint Anne St, Rapid City, SD 57701-4670 | 2006-02-16 |
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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.