NPIMap

Organization Active NPI

Sanford Medical Center Fargo

Doing business as Sanford LaMoure Clinic

  • Rural Health Clinic/Center
  • Lamoure, ND
National Provider Identifier
1164439196
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SANFORD MEDICAL CENTER FARGO
Doing business as
Sanford LaMoure Clinic
Practice address
100 1St Avenue SW
Suite 2
Lamoure, ND 58458-7311
Phone
(701) 883-5048
Fax
(701) 883-5067
NPI assigned
Aug 2, 2006
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

100 1St Avenue SW
Suite 2
Lamoure, ND 58458-7311

Mailing address

PO Box 2168
Fargo, ND 58107-2168
Phone (701) 234-2119

Other identifiers 4

IdentifierTypeStateIssuer
5132MedicaidND
1328001OtherNDBLUE SHIELD
CF8850OtherNDRAILROAD MEDICARE
12857MedicaidND

Other names 1

  • Sanford LaMoure Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110331000495 ND Part B Supplier - Clinic/Group Practice 8426967803 Receives reassigned benefits from 1,593 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20221212000920 ND Part A Provider - Rural Health Clinic 8426967803 Practice locations: Lamoure, ND
O20250325001289 ND Part A Provider - Rural Health Clinic 8426967803 Practice locations: Lamoure, ND

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1164439196. Details of each certification follow.

Rural health clinic certification: CCN 353844

Legal name
SANFORD MEDICAL CENTER FARGO
Doing business as
SANFORD HEALTH LAMOURE CLINIC
Certification status
Terminated Other: provider status change, Apr 1, 2025
Provider type (POS)
Rural health clinic
Participating since
May 22, 1996
Last certification
Jan 30, 2023
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2010 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1990 in ND
Enrollment address
100 1St Avenue SW
Lamoure, ND 58458-7419

Rural health clinic certification: CCN 353463

Legal name
SANFORD MEDICAL CENTER FARGO
Doing business as
SANFORD LAMOURE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2025
Last certification
Jan 30, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
100 1St Ave SW
Lamoure, ND 58458-7415
Related CCNs
350011

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.

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Hospital71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 33

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
Corporate DirectorTrustee Dec 4, 2014
Maria Caroline Bell Individual Corporate DirectorBoard Member Dec 1, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate DirectorDirector Feb 1, 2022
Corporate Director Jan 1, 2022
Tony Lee Morrison Individual Corporate OfficerVP, Revenue Cycle Feb 1, 1991
W-2 Managing EmployeeVP, Revenue Cycle Feb 1, 1991
Corporate OfficerVice President, Revenue Cycle Jan 19, 2020
W-2 Managing EmployeeVice President, Revenue Cycle Jan 19, 2020
James Edward Cain Individual Corporate DirectorBoard Member Nov 19, 2015
Karin Louise Dulski Individual W-2 Managing EmployeeDirector, Revenue Management Nov 19, 2012
Sanford Organization, Fargo, ND Non-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2011 100%
5% Or Greater Indirect Ownership Interest Jul 1, 2010 100%
Mark Roger Paulson Individual Corporate DirectorBoard Member Jul 1, 2010
Brent Gerard Teiken Individual Corporate DirectorBoard Member Mar 1, 2011
Corporate Director Jul 3, 2012
Jolyn Joy Munson Individual W-2 Managing EmployeeSenior Director, PFS Feb 25, 2013
Andrew Stewart North Individual Corporate DirectorBoard Member Jan 1, 2017
Corporate OfficerSecretary Dec 1, 2021
Corporate DirectorTrustee Dec 1, 2015
Stephanie Marie Swenson Individual W-2 Managing EmployeeDirector, Insurance Nov 1, 2019
Michelle Marie Micka Individual Corporate OfficerSr. Vice President, Finance Nov 6, 2019
W-2 Managing EmployeeSr. Vice President, Finance Nov 6, 2019
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
Corporate OfficerChief Executive Officer Nov 23, 2020
Corporate DirectorTrustee Nov 23, 2020
Wesley Owen Engbrecht Individual Corporate DirectorBoard of Trustes Jan 1, 2021
Corporate DirectorTrustee Jan 1, 2021
Donald Darwin Jacobs Individual Corporate DirectorBoard Member Dec 4, 2014
Michelle Ann Bruhn Individual Corporate OfficerCfo, VP,Treasurer Dec 2, 2021
W-2 Managing EmployeeCfo, VP,Treasurer Dec 2, 2021
Neil Leslie Gulsvig Individual Corporate Director Mar 28, 2019
Corporate DirectorTrustee Mar 28, 2019
Lauris Nelson Molbert Individual Corporate DirectorBoard of Trustees Nov 1, 2021
Corporate DirectorTrustee Jan 1, 2021
Robin Lisa Smith Individual Corporate DirectorBoard of Trustees Nov 1, 2021
Sanford North Organization, Bismarck, ND Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2011 100%
Susan Drake Jarvis Individual Corporate OfficerChief Operating Officer Jan 1, 2023
W-2 Managing EmployeeChief Operating Officer Jan 1, 2023
Kristin Kaye Herrmann Individual Corporate OfficerChief Financial Officer, Fargo Apr 24, 2022
W-2 Managing EmployeeChief Financial Officer, Fargo Apr 24, 2022
Dana James Dykhouse Individual Corporate DirectorTrustee Jan 1, 2024
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
Douglas Marlin Griffin Individual Corporate OfficerChief Physician Sep 25, 2022
W-2 Managing EmployeeChief Physician Sep 25, 2022
George Joseph Brown Individual Corporate DirectorTrustee Jan 1, 2025
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Tiffany L Lawrence Individual Corporate OfficerPresident Mar 3, 2022
W-2 Managing EmployeePresident Mar 3, 2022
Thomas Richard Wenzel Individual Corporate Director Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorTrustee Jan 1, 2024
Kevin Victor Schieffer Individual Corporate DirectorTrustee Jan 1, 2025
Nicholas Wayne Olson Individual Corporate OfficerChief Financial Officer Apr 8, 2024
W-2 Managing EmployeeChief Financial Officer Apr 8, 2024

Owners & managing parties with NPI records 2

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

Facilities with the same owner 42

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 42

Practitioners & affiliated clinicians

Practitioners 114

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 114

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1164439196",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 1ST AVENUE SW",
            "address_2": "SUITE 2",
            "city": "LAMOURE",
            "state": "ND",
            "postal_code": "584587311",
            "telephone_number": "701-883-5048",
            "fax_number": "701-883-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD MEDICAL CENTER FARGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "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": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5132",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1328001",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CF8850",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12857",
            "state": "ND"
        }
    ],
    "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",
            "affiliationName": "Cobius Healthcare Solutions",
            "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 LaMoure Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lamoure, ND

Sources for this page

Verify at the official NPI Registry.