AVERA ST. LUKE'S (NPI# 1245275189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245275189 |
| Entity Type | Organization |
| Organization Name | AVERA ST. LUKE'S |
| Other Organization Name | AVERA MEDICAL GROUP PEDIATRICS ABERDEEN |
| Practice Address |
201 S Lloyd St E205 Aberdeen SD 57401-4552 |
| Mailing Address |
Po Box 1460 Aberdeen SD 57402-1460 |
| Practice Telephone | 6056224050 |
| Practice Fax Number | 6056224049 |
| Mailing Telephone | 6056224050 |
| Mailing Fax Number | 6056224049 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2014-02-12 |
| Authorized Official Name | TODD FORKEL (PRESIDENT & CEO) |
| Authorized Official Telephone | 6056225125 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 10525 | SD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 14000 | 05 | |
| SD | DAKOTACARE | 9237225 | 01 |
| SD | WELLMARK BC/BS OF SD | 4993532 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Pediatrics Aberdeen | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336483551 | Avera St. Luke's | Internal Medicine | 310 S Penn St Ste 106, Aberdeen, SD 57401-4553 | 2012-11-15 |
| 1558624668 | Avera St. Luke's | Family Medicine | 501 Bloemendaal Drive, Ipswich, SD 57451 | 2012-06-22 |
| 1619273927 | Avera St. Luke's | Surgery | 4141 31st Ave S Ste 105, Fargo, ND 58104-8778 | 2011-02-03 |
| 1013143296 | Avera St. Luke's | Family Medicine | 105 S State St Ste 113, Aberdeen, SD 57401-4502 | 2009-06-02 |
| 1215100813 | Avera St. Luke's | Dietitian, Registered | 105 S State St Ste 201, Aberdeen, SD 57401-4502 | 2008-04-04 |
| 1154346625 | Avera St. Luke's | Family Medicine | 4401 Main St, Selby, SD 57472 | 2006-07-13 |
| 1124459391 | Avera St. Luke's | Orthopaedic Surgery | 701 8th Ave Nw, Aberdeen, SD 57401 | 2013-12-12 |
| 1982030177 | Avera St. Luke's | Physician Assistant | 815 1st Ave Se, Aberdeen, SD 57401-4602 | 2013-09-19 |
| 1083051817 | Avera St. Luke's | Anesthesiology | 815 1st Ave Se, Aberdeen, SD 57401 | 2013-06-03 |
| 1912265489 | Avera St. Luke's | Internal Medicine | 310 S Penn St, Ste 203, Aberdeen, SD 57401 | 2012-05-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AVERA ST LUKE'S HOSPITAL | 305 S State, Aberdeen, SD 57401-4527 |
| Street Address |
201 S LLOYD ST E205 |
| City | ABERDEEN |
| State | SD |
| Zip Code | 57401-4552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487651477 | Sanjay Mukerji | Surgery | 201 S Lloyd St, Suite W230, Aberdeen, SD 57401-4552 | 2005-07-05 |
| 1063805604 | Cosmetic and Plastic Surgery Specialists, PC | Plastic Surgery | 201 S Lloyd St, W230, Aberdeen, SD 57401-4552 | 2015-03-06 |
| 1356740781 | Joni Larson | Counselor | 201 S Lloyd St, Ste E201, Aberdeen, SD 57401-4552 | 2014-08-21 |
| 1538504832 | Thomas G. Harbert | Orthopaedic Surgery | 201 S Lloyd St, Suite 110, Aberdeen, SD 57401-4552 | 2013-05-01 |
| 1790036580 | Aberdeen Association of Orthopedic | Orthopaedic Surgery | 201 S Lloyd St, Suite W110, Aberdeen, SD 57401-4552 | 2012-09-20 |
| 1821363474 | Becky R Schuldt | Counselor | 201 S Lloyd St, Suite E201, Aberdeen, SD 57401-4552 | 2012-03-15 |
| 1578882387 | Aberdeen Asthma & Allergy PC | Allergy & Immunology | 201 S Lloyd St, W190, Aberdeen, SD 57401-4552 | 2010-05-19 |
| 1316279391 | Great Plains Rehabilitation Medicine, PC | Physical Medicine & Rehabilitation | 201 S Lloyd St, Ste. W130, Aberdeen, SD 57401-4552 | 2010-02-02 |
| 1881824977 | Avera St. Luke's | Psychiatry & Neurology | 201 S Lloyd St, Suite E202, Aberdeen, SD 57401-4552 | 2009-07-23 |
| 1851547798 | Avera St. Luke's | Surgery | 201 S Lloyd St, Suite W230, Aberdeen, SD 57401-4552 | 2008-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679002950 | Brenda Lee Pence | Registered Nurse | 305 S. State St., Aberdeen, SD 57401 | 2017-06-08 |
| 1104366475 | Jordan Shangreaux | Specialist/Technologist | 2200 S Roosevelt St, Aberdeen, SD 57401 | 2017-03-06 |
| 1205387545 | Midwest Medical Transport Company, LLC-aberdeen, Sd | Ambulance | 2919 Industrial Avenue, Aberdeen, SD 57401 | 2016-10-21 |
| 1356752471 | Cameron Eichler Enterprises | Hearing Aid Equipment | 110 6th Ave Se Ste 106, Aberdeen, SD 57401 | 2014-05-12 |
| 1184059412 | Richard Allen Ward IIi | Hearing Instrument Specialist | 1315 6th Avenue Se, Suite 4, Aberdeen, SD 57401 | 2013-09-05 |
| 1427395540 | Matthew William Svensen | Physical Therapist | 1109 S Jay St, Aberdeen, SD 57401 | 2013-01-09 |
| 1750655940 | Robert Ashly Froke | Audiologist | 121 4th Ave Sw-suite 1, Natural Hearing Center, Aberdeen, SD 57401 | 2012-03-06 |
| 1457504862 | Rodney S Johnson | Counselor | 14 S Main St Ste 1e, Aberdeen, SD 57401 | 2008-10-29 |
| 1518115005 | Dakota Chiropractic of Aberdeen, PC | Chiropractor | 520 Moccasin Drive, Aberdeen, SD 57401 | 2008-09-09 |
| 1558554626 | Tiffany Zimmerman Hoeft | Speech-Language Pathologist | 39515 Pintail Ave, Aberdeen, SD 57401 | 2007-08-22 |
| Find all providers in zip 57401 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720262421 | Sean Rae White | Pediatrics | 1812 Summer Ave, Aberdeen, WA 98520 | 2007-12-18 |
| 1760676886 | Sanford Health Network | Pediatrics | 3015 3rd Ave Se Ste 104, Aberdeen, SD 57401-5539 | 2007-08-31 |
| 1700965753 | Carmen Cabailo Briones | Pediatrics | 615 North F Street, Aberdeen, WA 98520 | 2006-11-02 |
| 1083721922 | William Steven Hutton | Pediatrics | 1100 Basich Blvd, Aberdeen, WA 98520-1066 | 2006-08-24 |
| 1497711824 | Julie M Mayo | Pediatrics | 1440 15th Ave Nw, Aberdeen, SD 57401-1846 | 2006-04-25 |
| 1629040894 | Tracy Lynne Russell | Pediatrics | 611 N F St, Ste 201, Aberdeen, WA 98520-2667 | 2006-02-02 |
| 1528582723 | Sheilla Kiconco | Pediatrics | 3015 3rd Ave Se Ste 104, Aberdeen, SD 57401-5539 | 2017-07-29 |
| 1952699266 | Sana Khizer | Pediatrics | 3015 3rd Ave Se, Ste 120, Aberdeen, SD 57401-5418 | 2011-07-20 |
| 1912292756 | Taha Saif | Pediatrics | 3015 3rd Ave Se, Aberdeen, SD 57401-5418 | 2011-06-09 |
| 1518266170 | Maria T. Martinez | Pediatrics | 615 North F Street, Aberdeen, WA 98520 | 2011-03-22 |
| Find all providers in ABERDEEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.