NPIMap

Organization Active NPI

S Sjoberg PLC

Doing business as Great River Eye Clinic

  • Health Service Clinic/Center
  • Crosby, MN
National Provider Identifier
1023424926
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
S SJOBERG PLC
Doing business as
Great River Eye Clinic
Practice address
1 3Rd Ave NE
Crosby, MN 56441-1665
Phone
(218) 546-5108
Fax
(218) 546-5736
NPI assigned
Jul 11, 2014
Last updated
Aug 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Authorized official

Name
Dr. Stacy Ann Sjoberg, M.D., PH.DNPI 1275584815
Title
Owner
Phone
(218) 546-5108

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X MN Primary
Optometrist 152W00000X
Corneal and Contact Management Optometrist 152WC0802X
Low Vision Rehabilitation Optometrist 152WL0500X
Pediatric Optometrist 152WP0200X
Sports Vision Optometrist 152WS0006X
Vision Therapy Optometrist 152WV0400X
Occupational Vision Optometrist 152WX0102X

Addresses

Primary practice location

1 3Rd Ave NE
Crosby, MN 56441-1665

Mailing address

1 3Rd Ave NE
Crosby, MN 56441-1665
Phone (218) 546-5108

Other names 1

  • Great River Eye Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140912001243 MN Part B Supplier - Clinic/Group Practice 0244459824 Receives reassigned benefits from 10 practitioners
Practice locations: Aitkin, MN; Baxter, MN; Brainerd, MN; Crosby, MN; Grand Rapids, MN; McGregor, MN; Onamia, MN; Staples, MN
O20150204001488 MN DME Supplier - Physician - OptometristDME Supplier - Optician 0244459824 Practice locations: Crosby, MN

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Great River Eye Clinic1 3Rd Ave NE, Crosby, MN 56441-1665(218) 546-5108 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Sep 19, 2014

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1023424926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 3RD AVE NE",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411665",
            "telephone_number": "218-546-5108",
            "fax_number": "218-546-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 3RD AVE NE",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411665",
            "telephone_number": "218-546-5108",
            "fax_number": "218-546-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S SJOBERG PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "SJOBERG",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-546-5108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great River Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crosby, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; 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.