| Wagner Community Clinic Avera | |
|
513 3rd St Sw Wagner SD 57380-9675 | |
| (605) 384-3418 | |
| (605) 384-5240 |
| Full Name | Wagner Community Clinic Avera |
|---|---|
| Speciality | Family Medicine |
| Location | 513 3rd St Sw, Wagner, South Dakota |
| Authorized Official Name and Position | Bernadette R Koupal (BUS. OFFICE MANAGER) |
| Authorized Official Contact | 6053843611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagner Community Clinic Avera Po Box 280 Wagner SD 57380-0280 Ph: (605) 384-3418 | Wagner Community Clinic Avera 513 3rd St Sw Wagner SD 57380-9675 Ph: (605) 384-3418 |
| NPI Number | 1740306992 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 03/07/2017 |
| Medicare PECOS PAC ID | 3577459700 |
|---|---|
| Medicare Enrollment ID | O20040225000391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740306992 | NPI | - | NPPES |
| S5877 | Other | SD | MEDICARE GROUP |
| 1008854 | Medicaid | SD |
| Provider Name | Kasey J Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346246493 PECOS PAC ID: 3779565593 Enrollment ID: I20060113000097 |
| Provider Name | Sean Clinton Halligan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1174504658 PECOS PAC ID: 4486661410 Enrollment ID: I20060504000412 |
| Provider Name | Riyad Mohama |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1194778738 PECOS PAC ID: 4284673104 Enrollment ID: I20071003000856 |
| Provider Name | Paul Olson |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1770538019 PECOS PAC ID: 4082668959 Enrollment ID: I20071023000582 |
| Provider Name | Tarek H Mahrous |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1225046436 PECOS PAC ID: 1557397486 Enrollment ID: I20080514000761 |
| Provider Name | Bruce Watt |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1922052075 PECOS PAC ID: 4082621115 Enrollment ID: I20090608000359 |
| Provider Name | Michael David Hibbard |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1629026422 PECOS PAC ID: 0244247377 Enrollment ID: I20100105000005 |
| Provider Name | Paul Lynn Carpenter |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1598723603 PECOS PAC ID: 5698782720 Enrollment ID: I20100118000115 |
| Provider Name | Christopher J Paa |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1265486138 PECOS PAC ID: 5294894556 Enrollment ID: I20100330000100 |
| Provider Name | Christopher M Stanton |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1457323081 PECOS PAC ID: 0749246809 Enrollment ID: I20100913000422 |
| Provider Name | David A Nagelhout |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1598718132 PECOS PAC ID: 2264452689 Enrollment ID: I20100927000722 |
| Provider Name | Raymond H Allen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396733705 PECOS PAC ID: 8729095856 Enrollment ID: I20101008000292 |
| Provider Name | Kelly D Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780751099 PECOS PAC ID: 7113937467 Enrollment ID: I20101021000074 |
| Provider Name | Tamara Wheeler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114085693 PECOS PAC ID: 8628116571 Enrollment ID: I20110111000375 |
| Provider Name | Carey C Buhler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265590749 PECOS PAC ID: 5991787137 Enrollment ID: I20110117000080 |
| Provider Name | Jeremy Wade Scott |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1629045828 PECOS PAC ID: 1951327907 Enrollment ID: I20110622000372 |
| Provider Name | Ralph J Tullo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225035751 PECOS PAC ID: 8426962978 Enrollment ID: I20120210000806 |
| Provider Name | Darcie L Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467729731 PECOS PAC ID: 0042478059 Enrollment ID: I20120222000547 |
| Provider Name | Philip R Kilmer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891748299 PECOS PAC ID: 8426098724 Enrollment ID: I20120423000218 |
| Provider Name | Jonathon C Adams |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1578683249 PECOS PAC ID: 2961594296 Enrollment ID: I20140703000461 |
| Provider Name | Lindsey Rae Nedved |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013377944 PECOS PAC ID: 1850699133 Enrollment ID: I20160420000732 |
| Provider Name | Jessica M Vanderham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285143891 PECOS PAC ID: 5991071409 Enrollment ID: I20171030000585 |
| Provider Name | Theresa A Petersen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649601287 PECOS PAC ID: 3274763164 Enrollment ID: I20180702001367 |
| Provider Name | Ryan Kocer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356824148 PECOS PAC ID: 0143565770 Enrollment ID: I20181228002329 |
| Provider Name | Mikaela J Koenig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609253806 PECOS PAC ID: 2567778236 Enrollment ID: I20190307001977 |
| Provider Name | Thomas M Waterbury |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1225392160 PECOS PAC ID: 2062658909 Enrollment ID: I20190715001786 |
| Provider Name | Mohammed Chowdhury |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1154674786 PECOS PAC ID: 6406150838 Enrollment ID: I20190802001071 |
| Provider Name | Sherrie Marie Brooks |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1720060858 PECOS PAC ID: 1355247362 Enrollment ID: I20200131000009 |
| Provider Name | John Francis Wagener |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1972879161 PECOS PAC ID: 5496003949 Enrollment ID: I20200805000798 |
| Provider Name | Cassie Lynn Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487263513 PECOS PAC ID: 1456778828 Enrollment ID: I20200831001407 |
| Provider Name | Berkley A Erickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619582699 PECOS PAC ID: 1850702283 Enrollment ID: I20201116002151 |
| Provider Name | Drew Garret Messerschmidt |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1467848655 PECOS PAC ID: 0749560118 Enrollment ID: I20210713003838 |
| Provider Name | Tianna Rose Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578129557 PECOS PAC ID: 2860888062 Enrollment ID: I20220414001244 |
| Provider Name | Dana Huether |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144954835 PECOS PAC ID: 9335522572 Enrollment ID: I20220819002384 |
| Provider Name | Tori Sarah Thaler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972231751 PECOS PAC ID: 9335510734 Enrollment ID: I20230123001636 |
| Provider Name | Sandra Ellen Fortuna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023216132 PECOS PAC ID: 6507237500 Enrollment ID: I20230131001371 |
| Provider Name | Jarod Myer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104517796 PECOS PAC ID: 9436517604 Enrollment ID: I20230620002503 |
| Provider Name | Jazmyn Soukup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154008332 PECOS PAC ID: 4688036809 Enrollment ID: I20230818002208 |
| Provider Name | Brooke Lynn Plooster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336924612 PECOS PAC ID: 4981068202 Enrollment ID: I20230919003319 |
| Provider Name | Ashley Ruhaak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104687235 PECOS PAC ID: 7416395561 Enrollment ID: I20240409001338 |
| Provider Name | Jodi Jean Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811743057 PECOS PAC ID: 1052753001 Enrollment ID: I20240522003624 |
Wagner Indian Health Service Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 111 Washington Ave, Wagner, SD 57380 Phone: 605-384-3621 Fax: 605-384-3293 | |
Prairie Health Clinic Wagner Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 W Sd Highway 46, Wagner, SD 57380 Phone: 605-724-2151 |