AVERA MCKENNAN (NPI# 1386610004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386610004 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP PULMONARY AND SLEEP MEDICINE SIOUX FALLS |
| Practice Address |
1301 S. Cliff Ave. Ste. 601 Sioux Falls SD 57105-1032 |
| Mailing Address |
2400 S. Minnesota Ave. Ste. 100 Sioux Falls SD 57105-3762 |
| Practice Telephone | 6053226930 |
| Practice Fax Number | 6053226931 |
| Mailing Telephone | 6053227510 |
| Mailing Fax Number | 6053226475 |
| Enumeration Date | 2006-02-23 |
| 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 | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBS MN | 286T1PU | 01 |
| SD | DEPT OF LABOR | 370624200 | 01 |
| MN | PRIME WEST | 92411422905 | 01 |
| IA | 0555169 | 05 | |
| SD | DAKOTACARE | 9202238 | 01 |
| SD | HEALTHPARTNERS | 84208 | 01 |
| MN | 984617400 | 05 | |
| SD | BCBS SD | 0040252 | 01 |
| MN | BLUE PLUS | 286T1PU | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Pulmonary and Sleep 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 |
1301 S. CLIFF AVE. STE. 601 |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-1032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669752358 | Amy Sue Thompson | Nurse Practitioner | 1301 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1023 | 2011-08-25 |
| 1346482890 | Margaret A Carmody | Neurological Surgery | 1301 S. Cliff Ave., Ste. 610, Sioux Falls, SD 57105-1032 | 2009-03-30 |
| 1114113693 | Avera Mckennan | Neurological Surgery | 1301 S. Cliff Ave., Sioux Falls, SD 57105-1032 | 2007-09-19 |
| 1134195332 | Avera Mckennan | Physical Medicine & Rehabilitation | 1301 S. Cliff Ave., Ste. 401, Sioux Falls, SD 57105-1053 | 2006-02-27 |
| 1912973785 | Fady Ghassan Jamous | Internal Medicine | 1301 S. Cliff Ave., Ste. 601, Sioux Falls, SD 57105-1032 | 2006-02-23 |
| 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 | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942483797 | Debbie Anne Chiu Qua | Internal Medicine | 1205 S Grange Ave, Ste 407, Sioux Falls, SD 57105-0407 | 2007-12-14 |
| 1205018363 | Noel Dexter Luis Tiangco | Internal Medicine | 1301 S Cliff Ave, Ste 601, Sioux Falls, SD 57105-1032 | 2007-11-30 |
| 1265457964 | Sanford Clinic | Internal Medicine | 1205 S Grange Ave, Ste 407, Sioux Falls, SD 57105-0410 | 2006-07-13 |
| 1932150968 | Rizan A Hajal | Internal Medicine | 6709 S. Minnesota Avenue, Pulmonary & Sleep Consultants, P.C. Suite 205, Sioux Falls, SD 57108-2593 | 2006-05-15 |
| 1912973785 | Fady Ghassan Jamous | Internal Medicine | 1301 S. Cliff Ave., Ste. 601, Sioux Falls, SD 57105-1032 | 2006-02-23 |
| 1700852480 | Brian T Hurley | Internal Medicine | 1301 S. Cliff Ave, Ste 601, Sioux Falls, SD 57105-1032 | 2006-02-23 |
| 1508850785 | Rodney Parry | Internal Medicine | 1310 W 22nd St, Sioux Falls, SD 57105-1501 | 2005-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932203015 | Avera St Lukes | Internal Medicine | 201 S Lloyd St Ste W240, Aberdeen, SD 57401-4530 | 2006-09-11 |
| 1912265489 | Avera St. Luke's | Internal Medicine | 310 S Penn St, Ste 203, Aberdeen, SD 57401 | 2012-05-02 |
| 1639327885 | Mohammad Hassan Alsumrain | Internal Medicine | 640 Flormann St, Rapid City, SD 57701-4679 | 2008-08-29 |
| 1336201953 | Javier E Bogarin | Internal Medicine | 353 Fairmont Blvd, Rapid City, SD 57701-7375 | 2006-12-14 |
| 1972530442 | Elmo J Rosario | Internal Medicine | 2805 5th St, Suite 100, Rapid City, SD 57701 | 2006-06-28 |
| 1821025552 | Thomas Shull Lemire | Internal Medicine | 353 Fairmont Blvd., Rapid City, SD 57701 | 2006-06-27 |
| 1295770568 | Daniel Y Rawson | Internal Medicine | 640 Flormann St, Rapid City, SD 57701-4679 | 2006-06-19 |
| 1407895113 | James D Mccafferty | Internal Medicine | 640 Flormann St, Rapid City, SD 57701-4679 | 2006-06-06 |
| 1720031610 | Siouxland Pulmonary Critical Care & Sleep PC | Internal Medicine | 101 Tower Road, Suite 200, Dakota Dunes, SD 57049-5098 | 2006-05-19 |
| 1053389130 | Masaru Chiba | Internal Medicine | 2805 5th St, Suite 100, Rapid City, SD 57701 | 2006-03-14 |
| Find all providers with the same taxonomy | ||||
| City | SIOUX FALLS |
| Zip Code | 57105 |
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.