NPIMap

Organization Active NPI

Avera St Lukes

Doing business as Avera Plaza Pharmacy

  • Pharmacy
  • Aberdeen, SD
National Provider Identifier
1801534045
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
AVERA ST LUKES
Doing business as
Avera Plaza Pharmacy
Practice address
2105 6TH Ave SE Ste 24
Aberdeen, SD 57401-6510
Phone
(605) 322-8331
NPI assigned
May 26, 2022
Last updated
May 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Authorized official

Name
Tess Moeller
Title
VP
Phone
(605) 622-2807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary

Addresses

Primary practice location

2105 6TH Ave SE Ste 24
Aberdeen, SD 57401-6510

Mailing address

911 E 20TH St Ste 500
Sioux Falls, SD 57105-1047
Phone (605) 322-8331

Other names 1

  • AVERA PLAZA PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230531001397 SD DME Supplier - Pharmacy 6406764927 Practice locations: Aberdeen, SD
O20240502001268 SD Part B Supplier - Mass Immunization (Roster Biller Only) 6406764927 1 other NPI on this enrollment
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).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Avera Plaza Pharmacy2105 6TH Ave SE, Aberdeen, SD 57401-6510(605) 225-6344 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf Accepts assignmentParticipating since Mar 1, 2023

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

2105 6th Ave SE
Ste 24
Aberdeen, SD 57401
Phone (605) 225-6344

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.

NPI Registry JSON

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1801534045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E 20TH ST STE 500",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051047",
            "telephone_number": "605-322-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 6TH AVE SE STE 24",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574016510",
            "telephone_number": "605-322-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST LUKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "MOELLER",
        "authorized_official_first_name": "TESS",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "605-622-2807"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVERA PLAZA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.