NPIMap

Organization Active NPI

Sanford Health of Northern Minnesota

Doing business as Sanford Health Occupational Medicine Clinic

  • Occupational Medicine Physician
  • Bemidji, MN
National Provider Identifier
1023496155
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
Legal business name
SANFORD HEALTH OF NORTHERN MINNESOTA
Doing business as
Sanford Health Occupational Medicine Clinic
Practice address
705 5TH St NW Ste B
Bemidji, MN 56601-2933
Phone
(218) 333-4735
NPI assigned
May 8, 2015
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
Tony Lee Morrison
Title
Vice President, Revenue Cycle
Phone
(605) 328-8380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Physician 2083X0100X NU Primary

Addresses

Primary practice location

705 5TH St NW Ste B
Bemidji, MN 56601-2933

Mailing address

2603 E Broadway Ave
Bismarck, ND 58501-5107
Phone (701) 323-8307

Other names 1

  • SANFORD HEALTH OCCUPATIONAL MEDICINE CLINIC Doing business as

Electronic endpoints 1

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150702001012 MN Part B Supplier - Clinic/Group Practice 5597725168 Receives reassigned benefits from 3 practitioners
Practice locations: Bemidji, MN

Other NPIs with the same Medicare PAC ID 20

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 20

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2016403Sanford Health Occupational Medicine705 5TH St NW Suite B, Bemidji, MN 56601Certificate of waiverNov 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
North Country Health Services23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

705 5th St NW
Ste B
Bemidji, MN 56601
Phone (218) 333-4735

Practitioners & affiliated clinicians

Practitioners 4

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": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1023496155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 E BROADWAY AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585015107",
            "telephone_number": "701-323-8307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 5TH ST NW STE B",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012933",
            "telephone_number": "218-333-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "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": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 OCCUPATIONAL MEDICINE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SANFORD HEALTH OCCUPATIONAL MEDICINE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bemidji, MN

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.
  • 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.