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Sanford Health of Northern Minnesota

Organization Active NPI Home Health Agency · Bemidji, MN

NPI 1215043633 · NPPES record last updated Nov 27, 2023

Key facts

NPI
1215043633
Entity type
Organization (NPI type 2)
Primary specialty
Home Health Agency 251E00000X
Legal business name
SANFORD HEALTH OF NORTHERN MINNESOTA
Practice address
3201 Pine Ridge Ave NW
Suite a
Bemidji, MN 56601-5101
Phone
(218) 333-5665
Fax
(218) 333-5642
NPI assigned
Aug 21, 2006
Organization subpart
Yes
Parent organization (as reported)
SANFORD HEALTH OF NORTHERN MINNESOTA

Authorized official

Name
Tony Lee Morrison
Title
Vice President, Revenue Cycle
Phone
(605) 328-8380

Owners & managing parties with NPI records 2

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

Other NPIs with the same Medicare PAC ID 20

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

Corporate family (same tax ID) 22

Organizations that report the same tax identification number in the National Provider Directory.

Facilities with the same owner 31

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

View all 31

Practitioners 349

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 349

Affiliated clinicians 25

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

Medicare Care Compare: Home health agency

Listed as
Sanford Bemidji Home Care and Hospice CCN 247215
Overall star rating
★★★★☆ 4 of 5
Ownership
Proprietary
Certified
Mar 7, 1986
Medicare certification status
Active (Provider of Services file)
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN

Home health agency certification: CCN 247215

Legal name
SANFORD HEALTH OF NORTHERN MINNESOTA
Doing business as
SANFORD BEMIDJI HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 7, 1986
Last certification
Jan 30, 2020
Ownership / control type
Proprietary
Organization structure
Corporation · Non-profit
Enrollment address
3201 Pine Ridge Ave NW
Ste a
Bemidji, MN 56601-5101

All disclosed owners & managing parties 24

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 Director
Trustee		 Dec 4, 2014
Jason Joseph Caron
Individual 		W-2 Managing Employee
President		 Jan 1, 2026
Marnie Lynn Ventling-Herrmann
Individual 		Corporate Director
Trustee		 Jan 1, 2022
Tony Lee Morrison
Individual 		W-2 Managing Employee
VP Chief Revenue Cycle Officer		 Jan 19, 2020
Daniel George Hoody
Individual 		W-2 Managing Employee
Chief Physician & Medical Officer		 Oct 9, 2023
Brent Gerard Teiken
Individual 		Corporate Director
Trustee		 Jul 3, 2012
Jolyn Joy Munson
Individual 		W-2 Managing Employee
VP Revenue Cycle Operations		 Apr 17, 2025
Dana James Dykhouse
Individual 		Corporate Director
Trustee		 Jan 1, 2024
Andrew Stewart North
Individual 		Corporate Director
Trustee		 Jan 1, 2017
Renee Marie Axtman
Individual 		W-2 Managing Employee
Chief Operations Officer		 Jan 1, 2026
Stephanie Marie Herseth Sandlin
Individual 		Corporate Director
Trustee		 Jan 1, 2024
William Joseph Gassen
Individual 		Corporate Director
Ceo, Trustee		 Nov 23, 2020
George Joseph Brown
Individual 		Corporate Director
Trustee		 Jan 1, 2025
Wesley Owen Engbrecht
Individual 		Corporate Director
Trustee		 Jan 1, 2021
Maureen Patricia McCausland
Individual 		Corporate Director
Trustee		 Jan 1, 2025
Sanford
Organization · Fargo, ND
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Mar 1, 2011 100%
Lisa Sue Miller
Individual 		W-2 Managing Employee
Chief Financial Officer		 Sep 9, 2019
Thomas Richard Wenzel
Individual 		Corporate Director
Trustee		 Jan 1, 2025
David Jonathan Shulkin
Individual 		Corporate Director
Trustee		 Jan 1, 2024
Neil Leslie Gulsvig
Individual 		Corporate Director
Trustee		 Mar 28, 2019
Kevin Victor Schieffer
Individual 		Corporate Director
Trustee		 Jan 1, 2025
Lauris Nelson Molbert
Individual 		Corporate Director
Trustee		 Jan 1, 2021
Nicholas Wayne Olson
Individual 		W-2 Managing Employee
Chief Financial Officer		 Apr 8, 2024
Sanford North
Organization · Bismarck, ND
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Mar 1, 2011 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100712000604 MN Part a Provider - Home Health Agency 5597725168 Practice locations: Bemidji, MN

National Provider Directory

Tax ID family
North Country Health SE (23 organizations share this tax ID)
Part of
North Country Health SE

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Yes

Addresses

Primary practice location

3201 Pine Ridge Ave NW
Suite a
Bemidji, MN 56601-5101

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1538ANOOtherMNBLUE CROSS BLUE SHIELD MN
5900073OtherMEDICA
890713700MedicaidMN
1014013OtherPREFERRED ONE

Other names

  • Sanford Bemidji Home Care Doing business as

Electronic endpoints

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

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1215043633",
    "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": "3201 PINE RIDGE AVE NW",
            "address_2": "SUITE A",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015101",
            "telephone_number": "218-333-5665",
            "fax_number": "218-333-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "enumeration_date": "2006-08-21",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-29",
        "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": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "1538ANO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5900073",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890713700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1014013",
            "state": null
        }
    ],
    "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 Bemidji Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Bemidji Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bemidji, MN

All providers in Bemidji, MN · Home Health Agency in Minnesota

Sources for this page

Verify at the official NPI Registry.