AVERA QUEEN OF PEACE — NPI 1649577297 (CLIA-Certified Diagnostic Medical & Pathology Laboratory in MITCHELL, SD)

CMS-1500 Box 24J / 33a • NPI

1649577297

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

291U00000X (CMS 69)

CLIA-Certified Diagnostic Medical & Pathology Laboratory

Box 32 Service Location & ZIP+4

1900 GRASSLAND DR., MITCHELL, SD, 57301-6205

✓ 9-Digit EDI 837 ZIP+4 (57301-6205)

Practice Phone & Referral Fax

(605) 995-7000

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1649577297 (AVERA QUEEN OF PEACE) 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	`1649577297` (NPI-2 Organization / Facility)
Provider / Legal Name	AVERA QUEEN OF PEACE
Plain-English Specialty	CLIA-Certified Diagnostic Medical & Pathology Laboratory NUCC Code: `291U00000X` (Clinical Medical Laboratory)
Certifying / Licensing Body	CMS CLIA / College of American Pathologists (CAP)
Practice Location Address	1900 GRASSLAND DR., MITCHELL, SD, 57301-6205
Practice Telephone / Fax	Tel: (605) 995-7000
Administrative Mailing Address	525 N FOSTER ST, MITCHELL, SD, 57301-2966
Enumeration & Last Sync	Enumerated: 2011-02-17 \| CMS Record Updated: 2020-08-20
Authorized Official	DOUGLAS EKEREN (President/CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1900 GRASSLAND DR., MITCHELL, SD, 57301-6205

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Plain-English Taxonomy & CMS Crosswalk (291U00000X)

What Does Taxonomy Code 291U00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 291U00000X translates to:
"CLIA-Certified Diagnostic Medical & Pathology Laboratory"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 69 (Clinical Laboratory) • CMS Code B4[14] (Histocompatibility Laboratory)
Certifying / Accrediting Authority: CMS CLIA / College of American Pathologists (CAP)
Clinical Scope: Fasting blood tests, bilirubin and liver function tests, kidney function (creatinine/eGFR), urine culture and sensitivity, or PCR molecular diagnostics.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AVERA QUEEN OF PEACE)

Typical CPT / Diagnostic Procedures:

Complete Blood Count (CBC) with Automated Differential (CPT 85025)
Comprehensive Metabolic Panel (CMP), Fractionated Bilirubin & Hepatic Panel
Quantitative Urine Culture & Colony Count (≥ 10⁵ CFU/mL) with Antibiotic Susceptibility
HbA1c, Lipid Panel, TSH & High-Sensitivity Troponin Assays

Common Therapeutic Classes:

Diagnostic Reagent Panels & CLSI Antimicrobial Susceptibility Disks/MIC Cards

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QR0200X` — Clinic/Center, Radiology Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: SD \| License: `63654` \| Primary: Secondary
`291U00000X` — Clinical Medical Laboratory Plain English: CLIA-Certified Diagnostic Medical & Pathology Laboratory	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AVERA QUEEN OF PEACE (NPI #1649577297)