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NPI 1669871000 · Sioux Falls, SD · Long Term Care Pharmacy
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Avera Mckennan is a long term care pharmacy provider located in Sioux Falls, South Dakota. This profile covers 8 Medicare and 10 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Avera Mckennan |
| Address | 4101 W Memory Circle |
| City | Sioux Falls |
| State | SD |
| ZIP | 57107 |
| Taxonomy | Long Term Care Pharmacy |
| NPI Enumerated | August 21, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $880.7K |
| Medicaid | $53.7K |
AVERA MCKENNAN is listed with a Long Term Care Pharmacy taxonomy and its Medicare billing mix is dominated by vaccine administration codes (91322, 90694, 90480), which implies the provider operates significant immunization services likely directed at older adults or residents in long‑term care settings. The presence of both product codes (e.g., 91322) and administration codes (e.g., 90480) indicates the organization both dispenses vaccine product and performs on‑site administration rather than solely supplying drugs to third parties.
Medicare revenue is highly concentrated: the top three Medicare codes account for 77.8% of this provider's total Medicare revenue, led by 91322 at $400.1K (45.4% of Medicare revenue), followed by 90694 at $176.5K (20.0%) and 90480 at $109.1K (12.4%). This concentration signals that immunization services are the primary driver of Medicare receipts for this entity.
On national competitive standing for Medicare vaccine services, AVERA MCKENNAN ranks near the top: 91322 ranks #18 of 29357 providers (100th percentile; notably above typical national volume), 90694 ranks #13 of 51679 providers (100th percentile; extreme outlier), and 90480 ranks #28 of 46950 providers (100th percentile; notably above typical national volume). These rankings indicate the provider is a major national outlier in volume for several vaccine-related codes, not a marginal participant.
Medicaid activity is much smaller and concentrated in durable medical/supply codes: the top three Medicaid codes account for 90.9% of Medicaid revenue, with T4527 at $26.6K (49.6%), A4335 at $19.2K (35.9%), and Q0513 at $2.9K (5.4%). This mix points to a Medicaid-facing business that primarily supplies incontinence products and other long‑term care consumables rather than generating material Medicaid vaccine revenue.
Competitive standing in-state on Medicaid is mixed: T4527 ranks #6 of 13 providers in-state (58th percentile) and A4335 ranks #14 of 27 (50th percentile), both described as typical, unremarkable volumes, whereas Q0513 ranks #1 of 11 providers in-state (100th percentile; notably above typical state volume). In plain terms, AVERA MCKENNAN is a modest statewide player for supplies but the leading state biller for the pharmacy dispensing fee for inhalation drugs.
The provider's payer mix is heavily Medicare‑weighted by scale: total Medicare revenue is $880.7K versus total Medicaid revenue of $53.7K, indicating Medicare drives the vast majority of reported public‑payer income and the organization functions, for reporting purposes, as effectively Medicare‑centric.
The NPI enumeration date is 2014-08-21 (~12 years ago), which indicates multi‑year registry tenure and suggests these billing patterns have had time to stabilize rather than reflecting a very new entrant.
Operationally, the combined picture—long term care pharmacy taxonomy, dominant Medicare vaccine billing, and Medicaid DME/incontinence supply revenue—suggests AVERA MCKENNAN runs recurring vaccination programs (seasonal influenza and COVID‑19) alongside standard LTC supply dispensing. This creates opportunities to negotiate vaccine administration reimbursement and supply contracts with payers and institutional customers, while also concentrating business risk around seasonal vaccine demand and payer reimbursement for supply items.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 2,800 | $140 | $400.1K |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 2,320 | $80 | $176.5K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 2,800 | $40 | $109.1K |
| 0124A | N/A | 2,010 | $40 | $78.3K |
| G0008 | Administration of influenza virus vaccine | 2,760 | $30 | $77.3K |
| 90677 | This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the… | 110 | $280 | $30.2K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 430 | $20 | $9.5K |
| G0009 | Administration of pneumococcal vaccine | 110 | $10 | $800 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 950 | $30 | $26.6K |
| A4335 | Incontinence supply; miscellaneous | 740 | $30 | $19.2K |
| Q0513 | Pharmacy dispensing fee for inhalation drug(s); per 30 days | 160 | $20 | $2.9K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 30 | $50 | $1.7K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 40 | $40 | $1.6K |
| A4927 | Gloves, non-sterile, per 100 | 110 | $10 | $1.5K |
| 0012A | N/A | 10 | $0 | $0 |
| 0124A | N/A | 50 | $0 | $0 |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 50 | $0 | $0 |
| G0008 | Administration of influenza virus vaccine | 50 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Dakota median
10 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 6 | 10 | 400 | $70 | $80.5K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 12 | 20 | 250 | $80 | $79.8K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 12 | 10 | 170 | $80 | $60.9K |
| A4335 | Incontinence supply; miscellaneous | 14 | 30 | 740 | $30 | $45.7K |
| 0124A | N/A | 11 | 20 | 70 | $150 | $31.3K |
| 0012A | N/A | 19 | 20 | 40 | $210 | $23.6K |
| A4927 | Gloves, non-sterile, per 100 | 8 | 10 | 110 | $20 | $15.9K |
| G0008 | Administration of influenza virus vaccine | 31 | 40 | 80 | $10 | $3K |
| Q0513 | Pharmacy dispensing fee for inhalation drug(s); per 30 days | 1 | 10 | 50 | $10 | $660 |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 1 | 10 | 20 | $0 | $0 |
Other providers in the same ZIP code as Avera Mckennan, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Avera Mckennan | SD | Home Infusion Agency | $0 | $6.7M |
| Eli Home Care LLC | SD | Home Health Agency | $0 | $1.5M |
| City Of Sioux Falls | SD | Federally Qualified Health Center (FQHC) | $0 | $210.4K |
| Walmart Inc. | SD | Community/Retail Pharmacy | $58.1K | $0 |
| Keri Orstad | SD | Family Medicine Physician | $50.6K | $0 |
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