WAGNER COMMUNITY CLINIC AVERA
NPI 1740306992
Family Medicine in Wagner, SD

Q: What is Wagner Community Memorial Hospital's NPI number?

The NPI number for Wagner Community Memorial Hospital is 1740306992. It was assigned to this organization in the NPPES registry on March 21, 2007. The provider is also known as Wagner Community Clinic Avera.

Q: What is Wagner Community Memorial Hospital's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since March 21, 2007

513 3RD ST SW, WAGNER, SD 57380(605) 384-3418(605) 384-5240 Get Directions Write a Review

NPPES record last updated: March 7, 2017. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Wagner Community Clinic Avera NPPES

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

WAGNER COMMUNITY CLINIC AVERA (NPI 1740306992) is a healthcare organization registered as a family medicine in Wagner, South Dakota and active in the NPI registry since March 2007. The organization lists Bernadette R Koupal, Bus. Office Manager, as its authorized official.

NPPES Registry Identity

NPI1740306992

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameWAGNER COMMUNITY MEMORIAL HOSPITAL

Location Address513 3RD ST SWWagner, SD 57380-9675

Mailing AddressPo Box 280Wagner, SD 57380-0280 · (605) 384-3418 · Fax (605) 384-5240

Phone(605) 384-3418

Fax(605) 384-5240

Organization SubpartNo

Authorized OfficialBernadette R KoupalBus. Office Manager · (605) 384-3611

Enumeration DateMarch 21, 2007

Last NPPES UpdateMarch 7, 2017

✔ NPI 1740306992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in SD · 10571

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedPhysician AssistantTaxonomy 363A00000X · License 10571 (SD)

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 10571 (SD)

513 3RD ST SW, Wagner, SD 57380

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Other Names 1

Other NameWagner Community Clinic Avera

Other Identifiers 2

OtherS5877SD · Medicare Group

Medicaid1008854SD

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Sunflower Health Plan, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wagner Community Clinic Avera is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 44 clinicians reassign Medicare billing to Wagner Community Clinic Avera, which bills Medicare for the services they deliver. Of these, 12 practice at this address and 15 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 11

Nurse Practitioner14

Internal Medicine6

Cardiovascular Disease (Cardiology)5

Diagnostic Radiology4

Cardiac Electrophysiology3

Clinical Social Worker3

Family Practice3

Interventional Cardiology3

3 other specialties3

Nearest to this location (20)

See all 44

Berkley Erickson, CNP

Nurse Practitioner

NPI 1619582699