NPIMap

Organization Active NPI

Avera St Lukes

Doing business as Avera Mother Joseph Manor

  • Skilled Nursing Facility
  • Aberdeen, SD
National Provider Identifier
1386693430
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
10590 Issued in SD
Legal business name
AVERA ST LUKES
Doing business as
Avera Mother Joseph Manor
Practice address
1002 N Jay St
Aberdeen, SD 57401-2439
Phone
(605) 622-5000
Fax
(605) 622-5255
NPI assigned
May 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ronald L Jacobson
Title
Chief Executive Officer
Phone
(605) 622-5125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 10590 SD Primary

Addresses

Primary practice location

1002 N Jay St
Aberdeen, SD 57401-2439

Mailing address

1002 N Jay St
Aberdeen, SD 57401-2439
Phone (605) 622-5000

Other identifiers 1

IdentifierTypeStateIssuer
0151162MedicaidSD

Other names 1

  • Avera Mother Joseph Manor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031024000030 SD Part A Provider - Skilled Nursing Facility 6406764927 Practice locations: Aberdeen, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386693430. Details of each certification follow.

Skilled nursing facility certification: CCN 435042

Legal name
AVERA ST LUKES
Doing business as
AVERA MOTHER JOSEPH MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 11, 1990
Last certification
May 16, 2024
Beds
81
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Avera Health
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 1998 in SD
Enrollment address
1002 N Jay St
Aberdeen, SD 57401-2439
Nursing home name
AVERA MOTHER JOSEPH MANOR RETIREMENT COMMUNITY
Affiliated entity
AVERA HEALTH

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avera Mother Joseph Manor Retirement CommunityCCN 435042 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
May 11, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8177.5 residents per day on average
Chain
Avera Health13 facilities in the chain
Penalties (3 years)
1Fines totaling $8,824

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D0681301Avera Mother Joseph Manor1002 N Jay St, Aberdeen, SD 57401Certificate of waiverAug 31, 2026

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

Locations

1002 N Jay St
Aberdeen, SD 57401
Phone (605) 622-5847

Ownership & related parties

All disclosed owners & managing parties 20

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
Organization, Fargo, ND Consulting firm, For-profit General Partnership Interest Dec 1, 2000
Limited Partnership Interest Dec 1, 2000
Adp of the SNF Feb 12, 2026
Michael J Knapp Individual Corporate DirectorMedical Director Mar 1, 2011
Operational/Managerial Control Mar 1, 2011
Adp of the SNF Feb 12, 2026
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 DirectorBoard Member Jul 1, 2014
David Merrill McNeil Individual Corporate DirectorBoard Member Jul 1, 2025
Amanda Marie Schutz Individual Corporate Officer Jul 1, 2018
Paula Rae Henrickson Individual Corporate OfficerAdministrator Mar 26, 2024
Operational/Managerial Control Mar 26, 2024
Adp of the SNF Feb 12, 2026
Daniel Bjerknes Individual Corporate OfficerPresident/Ceo 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 Corporation, Non-profit, Chain home office 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, 2024
Shane Franks Individual Corporate DirectorBoard Member Jul 1, 2024

Owners & managing parties with NPI records 3

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 1

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.

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386693430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 N JAY ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574012439",
            "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": "1002 N JAY ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574012439",
            "telephone_number": "605-622-5000",
            "fax_number": "605-622-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST LUKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "605-622-5125"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151162",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Mother Joseph Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.