Sanford Health Network

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

10533 Issued in SD

Legal business name

SANFORD HEALTH NETWORK

Practice address

701 3Rd Ave S
Clear Lake, SD 57226-2016

Phone

(605) 874-2141

Fax

(605) 874-3529

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Steve Goetsch

Title

Cfo

Phone

(605) 328-6940

Specialties & licenses 1

Addresses

Other names 1

• Sanford Clinic Deuel County Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Rural health clinic certification: CCN 433403

Legal name

SANFORD HEALTH NETWORK

Doing business as

SANFORD CLEAR LAKE CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 1, 1999

Last certification

Mar 18, 2024

Ownership / control type

2B

Most recent change of ownership

Jan 2, 1999 (1 total)

Organization structure

CorporationNon-profit

Incorporated

Aug 15, 1985 in SD

Enrollment address

701 3Rd Ave S
Clear Lake, SD 57226-2016

Related CCNs

431307

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Sanford Health Network

  • Critical Access Hospital
  • Clear Lake, SD
  • NPI 1851305296

  Parent provider

  Provider of Services

Other NPIs on the same Medicare enrollment 1

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

• Sanford Health Network

  • Rural Health Clinic/Center
  • Clear Lake, SD
  • NPI 1720129638

  O20070716000764

  Same enrollment

All disclosed owners & managing parties 18

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

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1083708267",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 3RD AVE S",
            "city": "CLEAR LAKE",
            "state": "SD",
            "postal_code": "572262016",
            "telephone_number": "605-874-2141",
            "fax_number": "605-874-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "GOETSCH",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-328-6940"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SD",
            "license": "10533",
            "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 Clinic Deuel County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Deuel County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Solomon Spears Nair, DMD
• Martin H Oleson, DDS
• Robert Payne, M.D.
• Megan Elizabeth Pederson
• Julie K Rasmussen, PAC
• Sanford Health Network
• Sanford Health Network
• Sanford Health Network
• Sanford Health Network
• Sanford Health Network

• Rural Health Clinic/Center in Clear Lake, SD
• Providers in Clear Lake, SD by specialty
• Rural Health Clinic/Center in South Dakota

• 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; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.