Sanford Medical Center Fargo

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

SANFORD MEDICAL CENTER FARGO

Practice address

24760 Hospital Dr
Red Lake, MN 56671

Phone

(218) 679-3117

Fax

(218) 676-4386

NPI assigned

Dec 13, 2006

Organization subpart

No

Name

Tony Lee Morrison

Title

Vice President, Revenue Cycle

Phone

(605) 328-8380

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

• Daniel W Louvar, M.D.

  • Nephrology Physician
  • Fargo, ND
  • NPI 1912984923

  Dialysis facility

  Care Compare affiliation Name & address match

Listed as

Sanford Dialysis Red LakeCCN 243534

Overall star rating

5.0 of 5

Ownership

Non-profit

Certified

Mar 30, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Sanford Health

Dialysis stations

8

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Tax ID family

Bemidji Same Day Surgery71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Sanford Medical Center Fargo

  • Internal Medicine Physician
  • Bemidji, MN
  • NPI 1093095382
  NPD tax ID
• Sanford Medical Center Fargo

  • Clinic Pharmacy
  • Moorhead, MN
  • NPI 1124122783
  NPD tax ID
• Sanford Medical Center Fargo

  • Eyewear Supplier
  • Detroit Lakes, MN
  • NPI 1124184403
  NPD tax ID
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • Bemidji, MN
  • NPI 1144500497
  NPD tax ID
• Sanford Medical Center Fargo

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Thief River Falls, MN
  • NPI 1154077824
  NPD tax ID
• Sanford Medical Center Fargo

  • Community/Retail Pharmacy
  • Alexandria, MN
  • NPI 1295374288
  NPD tax ID
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • New York Mills, MN
  • NPI 1366722647
  NPD tax ID
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • East Grand Forks, MN
  • NPI 1366722654
  NPD tax ID
• Sanford Medical Center Fargo

  • Internal Medicine Physician
  • Detroit Lakes, MN
  • NPI 1376823674
  NPD tax ID
• Sanford Medical Center Fargo

  • Occupational Health Nurse Practitioner
  • East Grand Forks, MN
  • NPI 1386099026
  NPD tax ID
• Sanford Medical Center Fargo

  • Optometrist
  • Detroit Lakes, MN
  • NPI 1427338722
  NPD tax ID
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • Perham, MN
  • NPI 1508146846
  NPD tax ID

• Sanford Dialysis Red Lake Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 27, 2023.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1124189741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2168",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581072168",
            "telephone_number": "701-234-2119",
            "fax_number": "701-234-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24760 HOSPITAL DR",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3117",
            "fax_number": "218-676-4386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD MEDICAL CENTER FARGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-31",
        "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": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "632605600",
            "state": "MN"
        }
    ],
    "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 Dialysis Red Lake",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Dialysis Red Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Leo Millen Robinson, DDS
• Rons Transport LLC
• Elizabeth Vivian Rose, DMD
• Ethan Ryberg, PHARMD
• Vanessa Ryberg, PHARMD
• Jennifer Marie Schoenborn
• Mark W Sellers, PHARM.D.
• Shani Lee Shriver, PHARM.D.
• Lacey Lynn Soto, LICSW
• John William Stender, PHYSICAL THERAPIST

• All providers in Red Lake, MN
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.