NPIMap

Organization Active NPI

Avera St Luke's

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Aberdeen, SD
National Provider Identifier
1649221664
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
AVERA ST LUKE'S
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
Aug 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

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
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031024000027 SD Part A Provider - End-Stage Renal Disease Facility (ESRD) 6406764927 Practice locations: Aberdeen, SD

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: Dialysis facility

Medicare Care Compare
Listed as
Avera St Lukes HospitalCCN 432302
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Jul 14, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
10

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Bowdle Hospital25 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 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.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1649221664",
    "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 LUKE'S",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "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": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.