AVERA MCKENNAN (NPI# 1346216074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346216074 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP DERMATOLOGY SIOUX FALLS |
| Practice Address |
6701 S Minnesota Ave Sioux Falls SD 57108-2591 |
| Mailing Address |
Po Box 86370 Sioux Falls SD 57118-6370 |
| Practice Telephone | 6053226960 |
| Practice Fax Number | 6053226961 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-07-31 |
| 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 | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 115182700 | 05 | |
| MN | BLUE PLUS | 396S9MI | 01 |
| MN | BCBS | 396S9MI | 01 |
| SD | DEPT OF LABOR | 370624200 | 01 |
| SD | BCBS | 0040219 | 01 |
| SD | DAKOTACARE | 9202239 | 01 |
| SD | HEALTHPARTNERS | 83986 | 01 |
| MN | PRIMEWEST | 040122003 | 01 |
| IA | 0554733 | 05 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Dermatology Sioux Falls | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 105 S State St Ste 202, Aberdeen, SD 574014501 | 6056228960 |
| 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 |
6701 S MINNESOTA AVE |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57108-2591 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669836276 | Emily Elizabeth Gaster | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2016-04-09 |
| 1154756054 | Sarah Catherine Engbers | Physician Assistant | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2013-09-10 |
| 1407141344 | Avera Mckennan | Pharmacy | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2011-06-17 |
| 1629373550 | Kimberly Dawn Dewing | Physician Assistant | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2011-01-25 |
| 1578737367 | Jenny Lynn Nelson | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2008-04-14 |
| 1669530671 | Heidi Marie Furth | Nurse Practitioner | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2006-12-04 |
| 1386754307 | Michelle Rae Wanna | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2006-08-30 |
| 1295701092 | Jana B Johnson | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2006-02-23 |
| 1720054539 | Brian Dennis Knutson | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2006-02-23 |
| 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 | 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 |
|---|---|---|---|---|
| 1992996771 | Valerie Flynn | Dermatology | 6701 S. Minnesota Ave, Sioux Falls, SD 57108-2591 | 2007-08-06 |
| 1669448387 | Dennis D Knutson | Dermatology | 116 W. 69th St., Ste. 100, Sioux Falls, SD 57108 | 2006-02-23 |
| 1598762544 | Sarah K Sarbacker | Dermatology | 4950 S Minnesota Ave, Sioux Falls, SD 57108-2864 | 2005-07-06 |
| 1669836276 | Emily Elizabeth Gaster | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2016-04-09 |
| 1740623776 | Kendra D Watson | Dermatology | 4950 S Minnesota Ave, Sioux Falls, SD 57108-2864 | 2013-04-09 |
| 1003051020 | Lazaderm Skin Care Centre PC | Dermatology | 5011 S Louise Ave, Sioux Falls, SD 57108-2268 | 2008-12-04 |
| 1982870820 | Carmen Marie Schwartz | Dermatology | 4950 S Minnesota Ave, Sioux Falls, SD 57108-2864 | 2008-04-30 |
| 1578737367 | Jenny Lynn Nelson | Dermatology | 6701 S Minnesota Ave, Sioux Falls, SD 57108-2591 | 2008-04-14 |
| 1023203619 | Sanford Clinic | Dermatology | 5019 S Western Ave, Ste 200, Sioux Falls, SD 57108-5095 | 2007-09-07 |
| 1265630719 | Sarah Christine Kerr | Dermatology | 1310 W 22nd St, Sioux Falls, SD 57105-1501 | 2007-07-06 |
| Find all providers in SIOUX FALLS | ||||
| City | SIOUX FALLS |
| Zip Code | 57108 |
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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.