NPIMap

Organization Active NPI

Sanford Health Network North

Doing business as Sanford Health Hillsboro Clinic

  • Rural Health Clinic/Center
  • Hillsboro, ND
National Provider Identifier
1265464259
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 Health Hillsboro Clinic
Practice address
315 E Caledonia Ave
Hillsboro, ND 58045-4701
Phone
(701) 636-5311
Fax
(701) 636-4514
NPI assigned
Jul 7, 2006
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

315 E Caledonia Ave
Hillsboro, ND 58045-4701

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
732216000MedicaidMN

Other names 1

  • Sanford Health Hillsboro 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 ND, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20171226001068 ND Part B Supplier - Clinic/Group Practice 8022206663 Receives reassigned benefits from 43 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thompson, ND; Mayville, ND; Hillsboro, ND; Grand Forks, ND; Finley, ND
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…
O20180205002996 ND Part A Provider - Rural Health Clinic 8022206663 Practice locations: Hillsboro, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265464259. Details of each certification follow.

Rural health clinic certification: CCN 353457

Legal name
SANFORD HEALTH NETWORK NORTH
Doing business as
SANFORD HILLSBORO CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2015
Last certification
Nov 27, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2018 in ND
Enrollment address
315 E Caledonia Ave
Hillsboro, ND 58045-4701
Related CCNs
351329

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 10

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

National Provider Directory

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 & Chief Executive Officer Nov 23, 2020
Corporate DirectorTrustee & Chief Executive Officer 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 DirectorTrustee Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND 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 Director 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 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": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1265464259",
    "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": "315 E CALEDONIA AVE",
            "city": "HILLSBORO",
            "state": "ND",
            "postal_code": "580454701",
            "telephone_number": "701-636-5311",
            "fax_number": "701-636-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-30",
        "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
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "732216000",
            "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 Health Hillsboro Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hillsboro, ND

Sources for this page

Verify at the official NPI Registry.