Avera St. Luke'S
Organization Active NPI Neurology Physician · Aberdeen, SD
NPI 1881824977 · NPPES record last updated Mar 31, 2016
Key facts
- NPI
- 1881824977
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 10525 (SD)
- Legal business name
- AVERA ST. LUKE'S
- 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Todd Forkel
- Title
- President & Ceo
- Phone
- (602) 622-5125
Other NPIs on the same Medicare enrollment 39
Practitioners 5
-
John Andrew Berg, MD
-
Tricia L Marcuson, CRNA
-
Tonya Myers, PT
-
Daniel Shih, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
201 S Lloyd St
Ste E202
Aberdeen, SD 57401
Phone (605) 622-2605
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | 10525 | SD | Yes |
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
- Avera Medical Group Neurology Aberdeen
NPI Registry JSON
{
"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
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Luke'S
- Avera St. Lukes
- Avera St. Lukes
All providers in Aberdeen, SD · Neurology Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.