NPIMap

Organization Active NPI

Sanford Clinic

Doing business as Sanford USD 34th & Kiwanis Family Medicine

  • Family Medicine Physician
  • Sioux Falls, SD
National Provider Identifier
1093997017
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANFORD CLINIC
Doing business as
Sanford USD 34th & Kiwanis Family Medicine
Sanford USD 34th & Kiwanis Family Medicine Clinic
Practice address
2701 S Kiwanis Ave
Sioux Falls, SD 57105-4252
Phone
(605) 328-0020
Fax
(605) 328-0021
NPI assigned
Nov 30, 2007
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Carolyn Tuttle
Title
VP of Revenue Cycle
Phone
(605) 328-8384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2701 S Kiwanis Ave
Sioux Falls, SD 57105-4252

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

320 W Main St
Canistota, SD 57012-2065
Phone (605) 296-3025

Other names 2

  • Sanford USD 34th & Kiwanis Family Medicine Doing business as
  • Sanford USD 34th & Kiwanis Family 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 SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000532 SD Part B Supplier - Clinic/Group Practice 0244143824 Receives reassigned benefits from 941 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1093997017",
    "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": "2701 S KIWANIS AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571054252",
            "telephone_number": "605-328-0020",
            "fax_number": "605-328-0021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 W Main St",
            "address_purpose": "LOCATION",
            "city": "Canistota",
            "state": "SD",
            "postal_code": "570122065",
            "country_code": "US",
            "telephone_number": "605-296-3025",
            "fax_number": "605-328-9101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "TUTTLE",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "605-328-8384"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "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 USD 34th & Kiwanis Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford USD 34th & Kiwanis Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford USD 34th & Kiwanis Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.