NPIMap

Organization Active NPI

Avera St. Luke's

Doing business as Avera Medical Group Neurology Aberdeen

  • Neurology Physician
  • Aberdeen, SD
National Provider Identifier
1881824977
Registry record updated Mar 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
10525 Issued in SD
Legal business name
AVERA ST. LUKE'S
Doing business as
Avera Medical Group Neurology Aberdeen
Practice address
201 S Lloyd St
Suite E202
Aberdeen, SD 57401-4552
Phone
(605) 622-2605
Fax
(605) 622-2606
NPI assigned
Jul 23, 2009
Last updated
Mar 31, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2016

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

Authorized official

Name
Mr. Todd Forkel
Title
President & Ceo
Phone
(602) 622-5125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 10525 SD Primary

Addresses

Primary practice location

201 S Lloyd St
Suite E202
Aberdeen, SD 57401-4552

Mailing address

PO Box 1460
Aberdeen, SD 57402-1460
Phone (602) 622-2605

Other names 1

  • Avera Medical Group Neurology Aberdeen 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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459382400000",
    "number": "1881824977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1460",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574021460",
            "telephone_number": "602-622-2605",
            "fax_number": "605-622-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S LLOYD ST",
            "address_2": "SUITE E202",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014552",
            "telephone_number": "605-622-2605",
            "fax_number": "605-622-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST. LUKE'S",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-23",
        "last_updated": "2016-03-31",
        "status": "A",
        "authorized_official_last_name": "FORKEL",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "602-622-5125",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SD",
            "license": "10525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Neurology Aberdeen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.