NPIMap

Organization Active NPI

Sanford Health Network

Doing business as Sanford Clinic Lakefield

  • Family Medicine Physician
  • Lakefield, MN
National Provider Identifier
1114086311
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANFORD HEALTH NETWORK
Doing business as
Sanford Clinic Lakefield
Practice address
209 Main Street
Lakefield, MN 56150
Phone
(507) 662-6611
Fax
(507) 662-5893
NPI assigned
Dec 6, 2006
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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 3

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

Addresses

Primary practice location

209 Main Street
Lakefield, MN 56150

Mailing address

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

Other names 2

  • Sanford Clinic Lakefield Doing business as
  • Sanford Health Network Other name

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 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…
O20080630000251 MN Part A Provider - Rural Health Clinic 6800707100 1 other NPI on this enrollment
Practice locations: Lakefield, MN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1114086311. Details of each certification follow.

Rural health clinic certification: CCN 243403A

Legal name
SANFORD HEALTH NETWORK
Doing business as
SANFORD CLINIC LAKEFIELD
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1985 in SD
Enrollment address
209 Main Street
Lakefield, MN 56150-1199

Rural health clinic certification: CCN 243403

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SANFORD CLINIC LAKEFIELD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 30, 1996
Last certification
Apr 23, 2013
Ownership / control type
2B
Most recent change of ownership
Jul 1, 1997 (1 total)
Facility address
209 Main Street PO Box 546
Lakefield, MN 56150
Related CCNs
241315

Other NPIs on the same Medicare enrollment 15

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

View all 15

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
24D0405248Sanford Jackson Lakefield Clinic209 Main Street, Lakefield, MN 56150ComplianceApr 26, 2027
24D1068946Sanford Clinic Lakefield209 Main Street, Lakefield, MN 56150Certificate of waiverMay 22, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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 DirectorDirector Jan 1, 2022
Tony Lee Morrison Individual Corporate OfficerSenior Executive Director Aug 1, 2019
W-2 Managing EmployeeSenior Executive Director Feb 1, 1991
James Edward Cain Individual Corporate DirectorBoard Member Nov 19, 2015
Karin Louise Dulski Individual W-2 Managing EmployeeDirector, Revenue Management Nov 19, 2012
Mark Roger Paulson Individual Corporate OfficerBoard Member Nov 2, 2009
Corporate DirectorBoard Member Nov 2, 2009
Brent Gerard Teiken Individual Corporate OfficerBoard Member Nov 9, 2012
Jolyn Joy Munson Individual W-2 Managing EmployeeDirector, Insurance Feb 25, 2013
William D Marlette Individual Corporate OfficerCfo Jun 16, 2023
W-2 Managing EmployeeCfo Jun 16, 2023
Andrew Stewart North Individual Corporate DirectorBoard Member Jan 1, 2017
William Joseph Gassen Individual Corporate OfficerPresident and Ceo Nov 24, 2020
Corporate DirectorPresident and Ceo Nov 24, 2020
W-2 Managing EmployeePresident and Ceo Nov 24, 2020
Wesley Owen Engbrecht Individual Corporate DirectorBoard of Trustes Jan 1, 2021
Sanford Organization, Fargo, ND Non-profit 5% Or Greater Indirect Ownership Interest Nov 2, 2009 100%
Donald Darwin Jacobs Individual Corporate DirectorBoard Member Dec 4, 2014
Sanford Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Aug 10, 2007 100%
Neil Leslie Gulsvig Individual Corporate DirectorBoard Member Mar 28, 2019
Lauris Nelson Molbert Individual Corporate DirectorBoard of Trustees Jan 1, 2021

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 1

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": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1114086311",
    "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": "507-662-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 MAIN STREET",
            "city": "LAKEFIELD",
            "state": "MN",
            "postal_code": "56150",
            "telephone_number": "507-662-6611",
            "fax_number": "507-662-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family 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 Clinic Lakefield",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Health Network",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakefield, MN

Sources for this page

Verify at the official NPI Registry.