NPIMap

Organization Active NPI

Sanford Health Network

Doing business as Sanford Clinic Jackson

  • Rural Health Clinic/Center
  • Jackson, MN
National Provider Identifier
1083638357
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SANFORD HEALTH NETWORK
Doing business as
Sanford Clinic Jackson
Practice address
1430 North Hwy
Jackson, MN 56143-1093
Phone
(507) 847-2200
Fax
(507) 847-3728
NPI assigned
Jul 27, 2006
Last updated
Mar 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Authorized official

Name
Tony Lee Morrison
Title
VP Chief Revenue Cycle Officer
Phone
(605) 328-8380

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1430 North Hwy
Jackson, MN 56143-1093

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Other practice location 1

25329 Alvwood Rd NE
Blackduck, MN 56630-4403
Phone (507) 847-2200

Other practice location 2

202 Industrial Park
Jackson, MN 56143-9448
Phone (507) 847-2200

Other names 1

  • Sanford Clinic Jackson Doing business as

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040715001116 MN Part B Supplier - Clinic/Group Practice 6800707100 Receives reassigned benefits from 308 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Windom, MN; Worthington, MN; Westbrook, MN; Walnut Grove, MN; Tracy, MN; Slayton, MN; Mountain Lake, MN; Lakefield, MN…
O20080630000143 MN Part A Provider - Rural Health Clinic 6800707100 1 other NPI on this enrollment
Practice locations: Jackson, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083638357. Details of each certification follow.

Rural health clinic certification: CCN 243985A

Legal name
SANFORD HEALTH NETWORK
Doing business as
SANFORD CLINIC JACKSON
Organization structure
CorporationNon-profit
Enrollment address
1430 North Hwy
Jackson, MN 56143-1093

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

Locations

1430 North Hwy
Jackson, MN 56143
Phone (507) 847-2200

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark Allen Lundeen Individual Corporate DirectorBoard Member Dec 4, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate DirectorBoard Member Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP & Chief Revenue Cycle Officer Jan 19, 2020
Michael Charles Wilde Individual W-2 Managing EmployeeMD; May 5, 2024
Brent Gerard Teiken Individual Corporate DirectorBoard Member Jul 3, 2012
Jolyn Joy Munson Individual W-2 Managing EmployeeVP, Revenue Cycle Operations Apr 17, 2025
Dana James Dykhouse Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew Stewart North Individual Corporate OfficerSecretary Dec 1, 2015
Corporate DirectorBoard Member Dec 1, 2015
Eric Lucas Vanden Hull Individual W-2 Managing EmployeeChief Financial Officer-Sioux Falls Sep 25, 2022
Jon Allen Pociask Individual Corporate OfficerPresident & Chief Operating Officer Aug 1, 2025
W-2 Managing EmployeePresident & Chief Operating Officer Aug 1, 2025
Stephanie Marie Herseth Sandlin Individual Corporate DirectorBoard Member Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerCeo Nov 23, 2020
Corporate DirectorBoard Member Nov 23, 2020
George Joseph Brown Individual Corporate OfficerTreasurer Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorBoard Member Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorBoard Member Jan 1, 2025
Sanford Organization, Fargo, ND Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 13, 2010 100%
Thomas Richard Wenzel Individual Corporate DirectorBoard Member Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorBoard Member Jan 1, 2024
Sanford Health Organization, Sioux Falls, SD Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 18, 1997 100%
Neil Leslie Gulsvig Individual Corporate DirectorBoard Member Mar 28, 2019
Kevin Victor Schieffer Individual Corporate DirectorBoard Member Jan 1, 2025
Lauris Nelson Molbert Individual Corporate DirectorBoard Member Jan 1, 2021
Nicholas Wayne Olson Individual W-2 Managing EmployeeChief Financial Officer Apr 8, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prairie Lakes Health Care System IncWatertown, SD, CCN 430005A Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2025
Windom Area HealthWindom, MN, CCN 241332 Hospital Operational/Managerial Control Jun 1, 1989
Windom Area HealthWindom, MN, CCN 24Z332 Hospital Operational/Managerial Control Jun 1, 1989
Sanford Webster Medical CenterBristol, SD, CCN 435093 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2000
Apr 7, 2025
Prairie Lakes Home HealthWatertown, SD, CCN 437019 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2025
Prairie Lakes HospiceWatertown, SD, CCN 431504 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2025

Facilities with the same owner 50

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 50

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773705600000",
    "number": "1083638357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585",
            "fax_number": "605-328-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 NORTH HWY",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431093",
            "telephone_number": "507-847-2200",
            "fax_number": "507-847-3728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25329 Alvwood Rd NE",
            "address_purpose": "LOCATION",
            "city": "Blackduck",
            "state": "MN",
            "postal_code": "566304403",
            "country_code": "US",
            "telephone_number": "507-847-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "202 Industrial Park",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MN",
            "postal_code": "561439448",
            "country_code": "US",
            "telephone_number": "507-847-2200",
            "fax_number": "507-847-3808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VP CHIEF REVENUE CYCLE OFFICER",
        "authorized_official_telephone_number": "605-328-8380"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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",
            "affiliationName": "Cobius Healthcare Solutions",
            "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 Clinic Jackson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MN

Sources for this page

Verify at the official NPI Registry.