NPIMap

Organization Active NPI

Avera St. Lukes

Doing business as Avera Medical Group Pathology Aberdeen

  • Clinical Pathology/Laboratory Medicine Physician
  • Aberdeen, SD
National Provider Identifier
1003195926
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
License
10525 Issued in SD
Legal business name
AVERA ST. LUKES
Doing business as
Avera Medical Group Pathology Aberdeen
Practice address
305 S State St
Aberdeen, SD 57401-4527
Phone
(605) 622-5000
NPI assigned
Aug 9, 2011
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tess Moeller, MD
Title
President and Ceo
Phone
(605) 622-2807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 10525 SD Primary

Addresses

Primary practice location

305 S State St
Aberdeen, SD 57401-4527

Mailing address

PO Box 4400
Aberdeen, SD 57402-4400
Phone (605) 622-5000

Other names 1

  • Avera Medical Group Pathology Aberdeen Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Amg Radiology Aberdeen25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1003195926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4400",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574024400",
            "telephone_number": "605-622-5000",
            "fax_number": "605-622-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S STATE ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014527",
            "telephone_number": "605-622-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST. LUKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "MOELLER",
        "authorized_official_first_name": "TESS",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "605-622-2807",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "SD",
            "license": "10525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Pathology Aberdeen",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Medical Group Pathology Aberdeen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.