NPIMap

Organization Active NPI

Sanford Clinic North

Doing business as Sanford Neuroscience Clinic

  • Clinical Neuropsychologist
  • Fargo, ND
National Provider Identifier
1023030046
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
SANFORD CLINIC NORTH
Doing business as
Sanford Neuroscience Clinic
Practice address
700 1St Ave S
Fargo, ND 58103-1802
Phone
(701) 234-4036
Fax
(701) 234-4134
NPI assigned
Jul 25, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X NU Primary
Psychologist 103T00000X NU
Neurological Surgery Physician 207T00000X NU
Neurology Physician 2084N0400X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

700 1St Ave S
Fargo, ND 58103-1802

Mailing address

700 1St Ave S
Fargo, ND 58103-1802
Phone (701) 234-4036

Other identifiers 1

IdentifierTypeStateIssuer
648513800MedicaidMN

Other names 1

  • Sanford Neuroscience Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

National Provider Directory

National Provider Directory
Tax ID family
Sanford Clinic North31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1023030046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 1ST AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031802",
            "telephone_number": "701-234-4036",
            "fax_number": "701-234-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 1ST AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031802",
            "telephone_number": "701-234-4036",
            "fax_number": "701-234-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD CLINIC NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "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": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "648513800",
            "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 Neuroscience Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Neuroscience Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • 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.