NPIMap

Organization Active NPI

Sanford Health Network North

Doing business as Sanford Wheaton Clinic

  • Rural Health Clinic/Center
  • Wheaton, MN
National Provider Identifier
1245524669
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SANFORD HEALTH NETWORK NORTH
Doing business as
Sanford Wheaton Clinic
Practice address
401 12TH St N
Wheaton, MN 56296-1070
Phone
(320) 563-8971
NPI assigned
Jun 2, 2011
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

401 12TH St N
Wheaton, MN 56296-1070

Mailing address

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

Other names 1

  • Sanford Wheaton Clinic 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 MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180205002429 MN Part B Supplier - Clinic/Group Practice 8022206663 Receives reassigned benefits from 232 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wheaton, MN; Ulen, MN; Thief River Falls, MN; Halstad, MN; Roseau, MN; Plymouth, MN; Pequot Lakes, MN; Moorhead, MN…
O20180222001076 MN Part A Provider - Rural Health Clinic 8022206663 Practice locations: Wheaton, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245524669. Details of each certification follow.

Rural health clinic certification: CCN 243435

Legal name
SANFORD HEALTH NETWORK NORTH
Doing business as
SANFORD WHEATON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 25, 2005
Last certification
Jun 22, 2016
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2011 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2018 in MN
Enrollment address
401 12TH St N
Wheaton, MN 56296-1070
Related CCNs
241304

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Sanford Health Network North14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Member organizations 9

Organizations listed as members of this organization in the National Provider Directory.

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 Jan 19, 2020
Brent Gerard Teiken Individual Corporate DirectorTrustee Jul 3, 2012
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 Apr 17, 2025
Dana James Dykhouse Individual Corporate DirectorTrustee Jan 1, 2024
Andrew Stewart North Individual Corporate OfficerTrustee & Secretary Jan 1, 2020
Corporate DirectorTrustee & Secretary Jan 1, 2017
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerTrustee & Ceo Nov 23, 2020
Corporate DirectorTrustee & Ceo Nov 23, 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 DirectorBoard of Trustes Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 20, 2010 100%
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 EmployeeCfo 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 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1245524669",
    "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": "401 12TH ST N",
            "city": "WHEATON",
            "state": "MN",
            "postal_code": "562961070",
            "telephone_number": "320-563-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Wheaton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheaton, MN

Sources for this page

Verify at the official NPI Registry.