Sanford Medical Center Fargo

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

SANFORD MEDICAL CENTER FARGO

Practice address

400 E 1St St
Morris, MN 56267-1408

Phone

(320) 589-2832

Fax

(701) 234-2045

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Tony Lee Morrison

Title

Vice President, Revenue Cycle

Phone

(605) 328-8380

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Sanford Dialysis Morris Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

Sanford Dialysis MorrisCCN 243530

Overall star rating

2.0 of 5

Ownership

Non-profit

Certified

Jun 24, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Sanford Health

Dialysis stations

6

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Raghavesh Pullalarevu, MD

  • Nephrology Physician
  • Royal Oak, MI
  • NPI 1689985079

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1013077007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2168",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581072168",
            "telephone_number": "320-589-2832",
            "fax_number": "320-589-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 1ST ST",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671408",
            "telephone_number": "320-589-2832",
            "fax_number": "701-234-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD MEDICAL CENTER FARGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VICE PRESIDENT, REVENUE CYCLE",
        "authorized_official_telephone_number": "605-328-8380"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBC",
            "identifier": "000026",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBC",
            "identifier": "4C29HME",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360419500",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sanford Dialysis Morris",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Dialysis Morris",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Reimers
• Tyler Reimers
• Revival Wellness LLC
• Evy Rodne-Cole, L.P.
• RWF Enterprises Inc
• Francine Schapiro
• John Henry Schmidgall
• Lauren Schmidgall, OTR/L
• Lori Jean Schmidt
• Seip Drug LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Morris, MN
• Providers in Morris, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.