NPIMap

Organization Active NPI

Sanford Health of Northern Minnesota

Doing business as Sanford Bemidji

  • Ambulatory Surgical Clinic/Center
  • Bemidji, MN
National Provider Identifier
1093876922
Registry record updated Nov 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SANFORD HEALTH OF NORTHERN MINNESOTA
Doing business as
Sanford Bemidji
Practice address
1233 34TH St NW
Bemidji, MN 56601-5112
Phone
(218) 333-5000
Fax
(701) 234-2045
NPI assigned
Dec 13, 2006
Last updated
Nov 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1233 34TH St NW
Bemidji, MN 56601-5112

Mailing address

1233 34TH St NW
Bemidji, MN 56601-5112
Phone (218) 333-5000

Other identifiers 4

IdentifierTypeStateIssuer
7Y46BEOtherMNBC
000026OtherNDBC
1028455OtherPREFERRED ONE
185297300MedicaidMN

Other names 1

  • Sanford Bemidji Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060425000776 ND Part A Provider - Hospital 8426967803 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20090529000206 MN Part B Supplier - Ambulatory Surgical Center 8426967803 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit Lakes, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093876922. Details of each certification follow.

Hospital certification: CCN 350011

Legal name
SANFORD MEDICAL CENTER FARGO
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 13, 2014
Beds
639
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1949 in ND
Enrollment address
801 Broadway N
Fargo, ND 58102-3641
Hospital subgroups
General

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sanford Medical Center FargoCCN 350011 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
North Country Health SE23 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

Ownership & related parties

All disclosed owners & managing parties 24

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 DirectorTrustee Dec 4, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate OfficerVice Chairperson Jan 1, 2024
Corporate DirectorTrustee Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP Chief Revenue Cycle Officer Jan 19, 2020
Brent Gerard Teiken Individual Corporate DirectorTrustee Jul 3, 2012
Susan Drake Jarvis Individual W-2 Managing EmployeeChief Operating Officer Jan 1, 2023
Kristin Kaye Herrmann Individual W-2 Managing Employee Apr 24, 2022
Jolyn Joy Munson Individual W-2 Managing EmployeeVP, Revenue Cycle Operations Apr 17, 2025
Dana James Dykhouse Individual Corporate DirectorTrustee Jan 1, 2024
Andrew Stewart North Individual Corporate OfficerSecretary Jan 1, 2020
Corporate DirectorTrustee Jan 1, 2017
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerChief Executive Officer Nov 23, 2020
Corporate DirectorTrustee Nov 23, 2020
Douglas Marlin Griffin Individual W-2 Managing EmployeeChief Physician Sep 25, 2022
George Joseph Brown Individual Corporate OfficerTreasurer Jan 1, 2025
Corporate DirectorTrustee Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorTrustee Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Nov 2, 2009 100%
Tiffany L Lawrence Individual Corporate OfficerPresident Mar 3, 2022
W-2 Managing EmployeePresident Mar 3, 2022
Thomas Richard Wenzel Individual Corporate DirectorTrustee Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorTrustee Jan 1, 2024
Neil Leslie Gulsvig Individual Corporate DirectorTrustee Mar 28, 2019
Kevin Victor Schieffer Individual Corporate DirectorTrustee Jan 1, 2025
Lauris Nelson Molbert Individual Corporate OfficerChairperson Jan 1, 2024
Corporate DirectorTrustee Jan 1, 2021
Nicholas Wayne Olson Individual W-2 Managing EmployeeChief Financial Officer Apr 8, 2024
Sanford North Organization, Bismarck, ND Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2011 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 1,401

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,401

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1093876922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 34TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015112",
            "telephone_number": "218-333-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 34TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015112",
            "telephone_number": "218-333-5000",
            "fax_number": "701-234-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2011-11-07",
        "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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBC",
            "identifier": "7Y46BE",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBC",
            "identifier": "000026",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1028455",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185297300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sanford Bemidji",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bemidji, MN

Sources for this page

Verify at the official NPI Registry.