NPIMap

Organization Active NPI

Sanford Health Network North

Doing business as Sanford Thief River Falls

  • Critical Access Hospital
  • Thief River Falls, MN
National Provider Identifier
1184781775
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
SANFORD HEALTH NETWORK NORTH
Doing business as
Sanford Thief River Falls
Practice address
3001 Sanford Pkwy
Thief River Falls, MN 56701-2700
Phone
(218) 683-2725
Fax
(218) 683-2595
NPI assigned
Jan 2, 2007
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SANFORD HEALTH NETWORK NORTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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
Critical Access Hospital 282NC0060X MN Primary

Addresses

Primary practice location

3001 Sanford Pkwy
Thief River Falls, MN 56701-2700

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
731047100MedicaidMN

Other names 1

  • Sanford Thief River Falls 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 MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220817002064 MN Part A Provider - Critical Access Hospital 8022206663 Practice locations: Thief River Falls, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184781775. Details of each certification follow.

Hospital certification: CCN 24Z381

Legal name
SANFORD HEALTH NETWORK NORTH
Doing business as
SANFORD THIEF RIVER FALLS (SWINGBED)
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2018 in ND
Enrollment address
3001 Sanford Pkwy
Thief River Falls, MN 56701-2700
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

National Provider Directory

National Provider Directory
Part of
Northwest Medical CNTR

Ownership & related parties

All disclosed owners & managing parties 23

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 DirectorTrustee Dec 4, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate OfficerTrustee/Vice Chairperson Jan 1, 2024
Corporate DirectorTrustee/Vice Chairperson Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP, Chief Revenue Cycle Officer Apr 8, 2024
Sanford Organization, Fargo, ND Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2011 100%
Brent Gerard Teiken Individual Corporate DirectorTrustee Nov 2, 2009
Susan Drake Jarvis Individual Corporate OfficerPresident Jan 1, 2023
W-2 Managing EmployeePresident Jan 1, 2023
Kristin Kaye Herrmann Individual W-2 Managing EmployeeChief Financial Officer, Fargo Apr 24, 2022
Jolyn Joy Munson Individual W-2 Managing EmployeeVP, Revenue Cycle Operations Feb 25, 2013
Dana James Dykhouse Individual Corporate DirectorTrustee Jan 1, 2024
Andrew Stewart North Individual Corporate OfficerTrustee/Secretary Jan 1, 2017
Corporate DirectorTrustee/Secretary Jan 1, 2017
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerTrustee/ Ceo Nov 24, 2020
Corporate DirectorTrustee/ Ceo Nov 24, 2020
Douglas Marlin Griffin Individual W-2 Managing EmployeeChief Physician, Fargo Sep 25, 2022
George Joseph Brown Individual Corporate OfficerTrustee/ Treasurer Jan 1, 2025
Corporate DirectorTrustee/ Treasurer Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorTrustee Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Thomas Richard Wenzel Individual Corporate DirectorTrustee Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorTrustee Jan 1, 2024
Neil Leslie Gulsvig Individual Corporate DirectorTrustee Mar 28, 2019
Kevin Victor Schieffer Individual Corporate DirectorTrustee Jan 1, 2025
Lauris Nelson Molbert Individual Corporate OfficerTrustee/ Chairperson Jan 1, 2024
Corporate DirectorTrustee/ Chairperson Jan 1, 2021
Nicholas Wayne Olson Individual W-2 Managing EmployeeChief Financial Officer Apr 8, 2024
Sanford North Organization, Bismarck, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2011 100%

Owners & managing parties with NPI records 1

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

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1184781775",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 SANFORD PKWY",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012700",
            "telephone_number": "218-683-2725",
            "fax_number": "218-683-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANFORD HEALTH NETWORK NORTH",
        "enumeration_date": "2007-01-02",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "731047100",
            "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 Thief River Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thief River Falls, MN

Sources for this page

Verify at the official NPI Registry.