NPIMap

Organization Active NPI

Avera St Lukes

  • Psychiatric Hospital Unit
  • Aberdeen, SD
National Provider Identifier
1003867029
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
10525 Issued in SD
Legal business name
AVERA ST LUKES
Practice address
305 S State St
Aberdeen, SD 57401-4527
Phone
(605) 622-5000
Fax
(605) 622-5255
NPI assigned
May 15, 2006
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
Title
Exec VP
Phone
(605) 622-2807

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 10525 SD Primary
Psychiatric Hospital 283Q00000X 10525 SD

Addresses

Primary practice location

305 S State St
Aberdeen, SD 57401-4527

Mailing address

305 S State St
Aberdeen, SD 57401-4527
Phone (605) 622-5000

Other identifiers 3

IdentifierTypeStateIssuer
2381MedicaidND
0230330MedicaidSD
0230332MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040120000912 SD Part B Supplier - Clinic/Group Practice 6406764927 Receives reassigned benefits from 271 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aberdeen, SD; Waubay, SD; Redfield, SD; Mobridge, SD; Groton, SD; Faulkton, SD; Britton, SD
O20070612000201 SD Part A Provider - Hospital 6406764927 Practice locations: Aberdeen, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003867029. Details of each certification follow.

Hospital certification: CCN 43S014

Legal name
AVERA ST LUKES
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 1998 in SD
Enrollment address
305 S State St
Aberdeen, SD 57401-4527
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Garret M Wobst Individual Corporate DirectorBoard Member Jul 1, 2018
Heidi Golz Individual Corporate DirectorBoard Member Jul 1, 2018
Michael Herman Individual Corporate DirectorBoard Member Jul 1, 2022
Kathleen Bierne Individual Corporate DirectorBoard Member Jul 1, 2018
Erin Hogan Fouberg Individual Corporate DirectorBoard Member Jul 1, 2025
Kristen Fauth Individual Corporate DirectorBoard Member Jul 1, 2022
Paula Jane Jensen Individual Corporate DirectorBoard Member Jul 1, 2023
Kathleen Kay Panowicz Individual Corporate Director Jul 1, 2011
David Merrill McNeil Individual Corporate DirectorBoard Member Jul 1, 2025
Daniel Bjerknes Individual Corporate OfficerPresident/Ceo Aug 15, 2022
Operational/Managerial Control Aug 15, 2022
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Marietta Kerkvliet Individual Corporate DirectorBoard Member Jul 1, 2018
Avera Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1998 100%
Operational/Managerial Control Jan 1, 1998
Blake Anthony Heinz Individual Corporate DirectorBoard Member Jul 1, 2025
Shane Franks Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eureka Community Health ServicesEureka, SD, CCN 431308 Hospital Operational/Managerial Control (25%) Aug 13, 1996
Eureka Community Health ServicesEureka, SD, CCN 43Z308 Hospital Operational/Managerial Control (25%) Aug 13, 1996
Marhsall County Healthcare CenterBritton, SD, CCN 431312 Hospital Operational/Managerial Control Apr 11, 2006
Marshall County Healthcare CenterBritton, SD, CCN 43Z312 Hospital Operational/Managerial Control Apr 11, 2006
Marshall County Healthcare CenterBritton, SD, CCN 433441 Rural health clinic Operational/Managerial Control Apr 22, 2006

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 90

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 90

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1003867029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 S STATE ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014527",
            "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",
            "fax_number": "605-622-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST LUKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "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": "EXEC VP",
        "authorized_official_telephone_number": "605-622-2807"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "SD",
            "license": "10525",
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "SD",
            "license": "10525",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2381",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230330",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230332",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.