NPIMap

Organization Active NPI

Avera St Lukes

  • Pathology Technician
  • Mobridge, SD
National Provider Identifier
1174548937
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pathology TechnicianTaxonomy code 246R00000X
Legal business name
AVERA ST LUKES
Practice address
1400 10TH Ave W
Mobridge, SD 57601-1246
Phone
(605) 845-7292
Fax
(605) 845-7812
NPI assigned
Jul 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Ron Jacobson
Title
President
Phone
(605) 622-5502

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Pathology TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 246R00000X Primary

Addresses

Primary practice location

1400 10TH Ave W
Mobridge, SD 57601-1246

Mailing address

1400 10TH Ave W
Mobridge, SD 57601-1246
Phone (605) 845-7292

Other names 1

  • Avera St Lukes Physician Specialist Clinic Doing business as

Medicare participation

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

Enrollment records 1

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

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1174548937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 10TH AVE W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576011246",
            "telephone_number": "605-845-7292",
            "fax_number": "605-845-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 10TH AVE W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576011246",
            "telephone_number": "605-845-7292",
            "fax_number": "605-845-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST LUKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-622-5502"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera St Lukes Physician Specialist Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobridge, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.