NPIMap

Organization Active NPI

Avera St. Luke's

Doing business as Marshall County Medical Clinic Avera

  • Family Medicine Physician
  • Britton, SD
National Provider Identifier
1659438828
Registry record updated Dec 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AVERA ST. LUKE'S
Doing business as
Marshall County Medical Clinic Avera
Practice address
415 9TH St
Britton, SD 57430-2274
Phone
(605) 448-5953
Fax
(605) 448-2304
NPI assigned
Jan 3, 2007
Last updated
Dec 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2011

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

Authorized official

Name
Mr. Ron L Jacobson
Title
President and Ceo
Phone
(605) 622-5125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

415 9TH St
Britton, SD 57430-2274

Mailing address

PO Box N
Britton, SD 57430-0626
Phone (605) 448-5953

Other names 1

  • Marshall County Medical Clinic Avera 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

Locations

701 8th Ave NW
Aberdeen, SD 57401
Phone (605) 225-3300

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

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.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1659438828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX N",
            "city": "BRITTON",
            "state": "SD",
            "postal_code": "574300626",
            "telephone_number": "605-448-5953",
            "fax_number": "605-448-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 9TH ST",
            "city": "BRITTON",
            "state": "SD",
            "postal_code": "574302274",
            "telephone_number": "605-448-5953",
            "fax_number": "605-448-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST. LUKE'S",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "RON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "605-622-5125",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marshall County Medical Clinic Avera",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Britton, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; 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.