AVERA ST LUKE'S — NPI 1619355633 (Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers

CMS-1500 Box 24J / 33a • NPI

1619355633

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

225100000X (CMS 65)

Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist

Box 32 Service Location & ZIP+4

805 1ST AVE SE, ABERDEEN, SD, 57401

Official NPPES Practice Location

Practice Phone & Referral Fax

(605) 622-5878

Fax: (605) 622-5888

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1619355633 (AVERA ST LUKE'S) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1619355633` (NPI-2 Organization / Facility)
Provider / Legal Name	AVERA ST LUKE'S
Plain-English Specialty	Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: `225100000X` (Physical Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	805 1ST AVE SE, ABERDEEN, SD, 57401
Practice Telephone / Fax	Tel: (605) 622-5878 \| Fax: (605) 622-5888
Administrative Mailing Address	PO BOX 4400, ABERDEEN, SD, 57402-4400
Enumeration & Last Sync	Enumerated: 2015-05-11 \| CMS Record Updated: 2026-04-30
Authorized Official	DANIEL BJERKNES (Regional President/CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

805 1ST AVE SE, ABERDEEN, SD, 57401

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Plain-English Taxonomy & CMS Crosswalk (225100000X)

What Does Taxonomy Code 225100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 65 (Physical Therapist in Private Practice)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AVERA ST LUKE'S)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`235Z00000X` — Speech-Language Pathologist, Plain English: Licensed & Credentialed Speech, Language and Hearing Service Providers	State: N/A \| License: `Verified` \| Primary: Secondary
`225X00000X` — Occupational Therapist Plain English: Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab)	State: N/A \| License: `Verified` \| Primary: Secondary
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AVERA ST LUKE'S (NPI #1619355633)