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AVERA MEDICAL GROUP FAIRFAX
NPI 1215967203
Clinic/Center in Fairfax, SD

Active since July 04, 2006CLIA 43D0047742 · Microscopy
421 MAIN ST, FAIRFAX, SD 57335(605) 654-2366 Get Directions Write a Review

NPPES record last updated: March 21, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Avera Medical Group Fairfax NPPES

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

AVERA MEDICAL GROUP FAIRFAX (NPI 1215967203) is a healthcare organization registered as a clinic/center in Fairfax, South Dakota and active in the NPI registry since July 2006. The organization holds a CLIA Microscopy certificate valid through August 31, 2026 and lists Julie N Norton, Vice President Of Finance, as its authorized official.

NPPES Registry Identity

NPI1215967203
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameAVERA MCKENNAN
Location Address421 MAIN STFairfax, SD 57335-0354
Mailing AddressPo Box 354, 421 MainFairfax, SD 57335-0354 · (605) 654-2366
Phone(605) 654-2366
Organization SubpartNo
Authorized OfficialJulie N NortonVice President Of Finance · (605) 322-6375
Enumeration DateJuly 4, 2006
Last NPPES UpdateMarch 21, 2011
✔ NPI 1215967203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
421 MAIN ST, Fairfax, SD 57335
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Other Names 1

Doing Business AsAvera Medical Group Fairfax

Other Identifiers 5

Medicare ID-Type Unspecified28SD
Medicaid=========12NE
Medicare PINCD8978
Other0000028SD · Wellmark Bc/bs
Medicare PINS28SD

Accepted Insurance

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

CLIA Laboratory Certificates CMS CLIA

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 for Provider-Performed Microscopy Procedures (PPMP) 43D0047742

Avera Medical Group Fairfax · Fairfax, SD
Active · expires Aug 31, 2026
CLIA Number43D0047742
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorRichard G. Kafka
Laboratory Phone(605) 654-2366
Laboratory LocationAvera Medical Group FairfaxMain St PO Box 354, Fairfax, SD 57335
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Avera Mckennan's NPI number?

The NPI number for Avera Mckennan is 1215967203. It was assigned to this organization in the NPPES registry on July 4, 2006. The provider is doing business as Avera Medical Group Fairfax.

Where is Avera Mckennan located?

Avera Mckennan is located at 421 Main St, Fairfax, SD 57335. The listed phone number is (605) 654-2366.

What is Avera Mckennan's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Avera Mckennan hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 43D0047742) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Avera Mckennan accept?

Health plans from Avera Health Plans and Medica list Avera Mckennan as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Avera Mckennan was last updated on March 21, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.