Sanford Health Network

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SANFORD HEALTH NETWORK

Practice address

321 Main St
Sanborn, IA 51248-0400

Phone

(712) 729-3545

Fax

(712) 729-5767

NPI assigned

Oct 19, 2006

Organization subpart

Yes

Parent organization

SANFORD HEALTH NETWORKAs reported in NPPES

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

Authorized official

Name

Joel Mason Gustafson

Title

Administrator

Phone

(712) 324-5356

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sanford Clinic Sanborn Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Rural health clinic certification: CCN 168505

Legal name

SANFORD HEALTH NETWORK

Doing business as

SANFORD CLINIC SANBORN

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 1, 2006

Last certification

Nov 25, 2025

Ownership / control type

1B

Most recent change of ownership

May 2, 2006 (1 total)

Organization structure

CorporationNon-profit

Incorporated

Aug 15, 1985 in SD

Enrollment address

321 Main St
Sanborn, IA 51248-7731

Other NPIs on the same Medicare enrollment 1

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

• Sanford Health Network

  • Family Medicine Physician
  • Sanborn, IA
  • NPI 1831372077

  O20070103000130

  Same enrollment

Part of

Sioux Valley Vermillion

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.

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1144302191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 MAIN ST",
            "address_2": "P.O. BOX 400",
            "city": "SANBORN",
            "state": "IA",
            "postal_code": "512480400",
            "telephone_number": "712-729-3545",
            "fax_number": "712-729-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 MAIN ST",
            "city": "SANBORN",
            "state": "IA",
            "postal_code": "512480400",
            "telephone_number": "712-729-3545",
            "fax_number": "712-729-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANFORD HEALTH NETWORK",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "MASON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "712-324-5356"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0638593",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0254656",
            "state": "IA"
        }
    ],
    "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 Sanborn",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Sanborn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mitchell Ludwig, DC
• Prairie View
• Prairie View Leasing
• Melissa S Rupp, DC
• Sanborn Chiropractic Clinic PC
• Sanford Health Network
• Terry L Boelter DDS PC
• Alexander Vaughn

• All providers in Sanborn, IA
• Rural Health Clinic/Center in Iowa

• 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.