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Organization Active NPI

Avera St Lukes

Doing business as Avera St Lukes Hospital Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Aberdeen, SD
National Provider Identifier
1013968940
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
10525 Issued in SD
Legal business name
AVERA ST LUKES
Doing business as
Avera St Lukes Hospital Swingbed
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
VP
Phone
(605) 622-2807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 10525 SD Primary

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 names 1

  • AVERA ST LUKES HOSPITAL SWINGBED Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070612000221 SD Part A Provider - Hospital 6406764927 Practice locations: Aberdeen, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013968940. Details of each certification follow.

Hospital certification: CCN 43U014

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 Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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).

National Provider Directory

National Provider Directory
Tax ID family
Mobridge Family Practic25 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

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 Jan 1, 2014
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 DirectorBioard 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

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": "1013968940",
    "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": "VP",
        "authorized_official_telephone_number": "605-622-2807"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "SD",
            "license": "10525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVERA ST LUKES HOSPITAL SWINGBED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.