Sanford Clinic North

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SANFORD CLINIC NORTH

Doing business as

Sanford Health 621 Demers Ave Clinic

Practice address

621 Demers Ave
East Grand Forks, MN 56721-1833

Phone

(218) 773-5800

Fax

(218) 773-5888

NPI assigned

Jun 18, 2006

Last updated

Nov 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Martha K Leclerc

Title

VP

Phone

(701) 234-6248

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sanford Health 621 Demers Ave Clinic Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1013952605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 DEMERS AVE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211833",
            "telephone_number": "218-773-5800",
            "fax_number": "218-773-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 DEMERS AVE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211833",
            "telephone_number": "218-773-5800",
            "fax_number": "218-773-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD CLINIC NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "LECLERC",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "701-234-6248"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "398687000",
            "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 Health 621 Demers Ave Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Health 621 Demers Ave Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Riverview Healthcare Association
• Riverview Healthcare Association
• Juan Rosales Jr.
• Jocelyn Rozeveld
• Saeed Amin Saeed
• Sanford Clinic North (Sanford Health 929 Central Ave Clinic)
• Sanford Medical Center Fargo (Sanford Health 621 Demers Ave Clinic)
• Sanford Medical Center Fargo (Sanford Health Occupational Medicine Clinic)
• Sanford Medical Center Fargo (Sanford Health 929 Central Ave Clinic)
• Rebecca Schulz, FNP

• Family Medicine Physician in East Grand Forks, MN
• Providers in East Grand Forks, MN by specialty
• Family Medicine Physician 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.