Avera St Lukes
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Aberdeen, SD
NPI 1013968940 · NPPES record last updated Jul 15, 2022
Key facts
- NPI
- 1013968940
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 10525 (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
- Organization subpart
- No
Authorized official
- Name
- Tess Moeller
- Title
- VP
- Phone
- (605) 622-2807
Owners & managing parties with NPI records 2
-
Blake Anthony Heinz, D.O.
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 24
Related certifications (CCN) 1
Facilities with the same owner 90
Practitioners 164
-
Arslan Ahmed, DO
-
Wylie Leroy Barnes, ACNP
-
James R Barnett, CRNA
-
Julie Berry, PT
-
Lyle W Biegler, MD
-
Paul A Bormes, MD
-
Kelly M Brennan, PT
-
Tiffany Bruckner, CNP
-
Grace Caldwell, MD
-
Gregg W Carlson, MD
-
Robert A Cihak, M.D.
-
Julie Ann Cox, CNP
-
Katie Barett Duffney, MA, CCC-SLP
-
Brian D Ermer, PAC
-
Chad A Falken, PT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Hospital certification: CCN 43U014
- Legal name
- AVERA ST LUKES
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 17, 1998 in SD
- Enrollment address
- 305 S State St
Aberdeen, SD 57401-4527 - Hospital subgroups
- Swing-bed approved
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| James Francis Dover |
Corporate Officer |
Oct 23, 2023 | |
| Garret M Wobst |
Corporate Director |
Jul 1, 2018 | |
| Heidi Golz |
Corporate Director |
Jul 1, 2018 | |
| Michael Herman |
Corporate Director |
Jul 1, 2022 | |
| Kathleen Bierne |
Corporate Director |
Jul 1, 2018 | |
| Erin Hogan Fouberg |
Corporate Director |
Jul 1, 2025 | |
| Kristen Fauth |
Corporate Director |
Jul 1, 2022 | |
| Paula Jane Jensen |
Corporate Director |
Jul 1, 2023 | |
| Kathleen Kay Panowicz |
Corporate Director | Jan 1, 2014 | |
| David Merrill McNeil |
Corporate Director |
Jul 1, 2025 | |
| Daniel Bjerknes |
Corporate Officer |
Aug 15, 2022 | |
| Operational/Managerial Control | Aug 15, 2022 | ||
| Julie Lautt |
Corporate Officer |
Mar 1, 2020 | |
| Marietta Kerkvliet |
Corporate Director |
Jul 1, 2018 | |
| Avera Health |
5% Or Greater Direct Ownership Interest | Jan 1, 1998 | 100% |
| Operational/Managerial Control | Jan 1, 1998 | ||
| Blake Anthony Heinz |
Corporate Director |
Jul 1, 2025 | |
| Shane Franks |
Corporate Director |
Jul 1, 2023 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Eureka Community Health Services |
Hospital | Operational/Managerial Control (25%) | Aug 13, 1996 |
| Eureka Community Health Services |
Hospital | Operational/Managerial Control (25%) | Aug 13, 1996 |
| Marhsall County Healthcare Center |
Hospital | Operational/Managerial Control | Apr 11, 2006 |
| Marshall County Healthcare Center |
Hospital | Operational/Managerial Control | Apr 11, 2006 |
| Marshall County Healthcare Center |
Rural health clinic | Operational/Managerial Control | Apr 22, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070612000221 | SD | Part a Provider - Hospital | 6406764927 | Practice locations: Aberdeen, SD |
National Provider Directory
- Tax ID family
- St Luke Mid Reg Hospdm
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 10525 | SD | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0159010 | Medicaid | SD | |
| 01953 | Medicaid | ND | |
| 8U014 | Other | SD | HOSPITAL SWINGBED UNIT |
Other names
- AVERA ST LUKES HOSPITAL SWINGBED
Other providers in Aberdeen, SD
- Avera St Luke'S
- Avera St Luke'S
- Avera St Luke'S
- Avera St Luke'S
- Avera St Lukes
- Avera St Lukes
- Avera St Lukes
- Avera St Lukes
- Avera St Lukes
- Avera St Lukes
All providers in Aberdeen, SD · Medicare Defined Swing Bed Hospital Unit in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.