AVERA MEDICAL GROUP
NPI 1013350891
Emergency Medicine in Sioux Falls, SD

Q: What is Avera Mckennan's NPI number?

The NPI number for Avera Mckennan is 1013350891. It was assigned to this organization in the NPPES registry on April 11, 2013. The provider is doing business as Avera Medical Group.

Q: What is Avera Mckennan's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Q: When was this NPI record last updated?

The NPPES record for Avera Mckennan was last updated on January 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 11, 2013CLIA Certified · 3 labs

4500 W 69TH ST, SIOUX FALLS, SD 57108(605) 322-9777 Get Directions Write a Review

NPPES record last updated: January 12, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 12, 2023, Oct 24, 2018 (2 updates tracked since 2018).

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About Avera Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AVERA MEDICAL GROUP (NPI 1013350891) is a healthcare organization registered as an emergency medicine in Sioux Falls, South Dakota and active in the NPI registry since April 2013. The organization holds 3 active CLIA laboratory certificates, maintains a secondary practice location in Sioux Falls, and lists David Flicek, Ceo/president, as its authorized official.

NPPES Registry Identity

NPI1013350891

Entity TypeOrganization

Primary Taxonomy207P00000X

Legal Business NameAVERA MCKENNAN

Location Address4500 W 69TH STSioux Falls, SD 57108-8148

Mailing AddressPo Box 86370Sioux Falls, SD 57118-6370 · (605) 322-7510 · Fax (605) 322-6475

Phone(605) 322-9777

Organization SubpartNo

Authorized OfficialDavid FlicekCeo/president · (605) 322-8000

Enumeration DateApril 11, 2013

Last NPPES UpdateJanuary 12, 20232 updates tracked since enumeration

NPPES CertifiedJanuary 12, 2023

✔ NPI 1013350891 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207P00000X

Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

4500 W 69TH ST, Sioux Falls, SD 57108

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Other Names 1

Doing Business AsAvera Medical Group

Secondary Practice Location 1

Location 14500 N Lewis AveSioux Falls, SD 57104-7111 · Phone (605) 322-4767 · Fax (605) 322-2096

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica.Insurance ›

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 43D1069059

Avera Medical Group Mcgreevy 69th & Western · Sioux Falls, SD

Active · expires Jun 23, 2028

CLIA Number43D1069059

Laboratory TypePhysician Office

Certificate Effective DateJune 24, 2026

Certificate Expiration DateJune 23, 2028

Laboratory DirectorDr. Carilyn Van Kalsbeek

Laboratory Phone(605) 504-5204

Laboratory LocationAvera Medical Group Mcgreevy 69th & Western1910 West 69th Street, Sioux Falls, SD 57108

CLIA data matches this NPI record on: Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 43D0719165

Avera Medical Group Health Care Clinic · Sioux Falls, SD

Active · expires Mar 31, 2027

CLIA Number43D0719165

Laboratory TypeCommunity Clinic

Certificate Effective DateApril 1, 2025

Certificate Expiration DateMarch 31, 2027

Laboratory DirectorJohn Srstka

Laboratory Phone(605) 322-6827

Laboratory LocationAvera Medical Group Health Care Clinic300 North Dakota Avenue Suite 117, Sioux Falls, SD 57104

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 43D0935209

Avera Medical Group Mcgreevy 69th And Cliff · Sioux Falls, SD

Active · expires Mar 19, 2027

CLIA Number43D0935209

Laboratory TypeCommunity Clinic

Certificate Effective DateMarch 20, 2025

Certificate Expiration DateMarch 19, 2027

Laboratory DirectorDr. Prasuna Muppa

Laboratory Phone(605) 504-5204

Laboratory LocationAvera Medical Group Mcgreevy 69th And Cliff6215 South Cliff, Sioux Falls, SD 57108

CLIA data matches this NPI record on: Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTOPHER M BARTEK CRNA

Nurse Anesthetist, Certified Registered