NPIMap

Organization Active NPI

Sanford Medical Center Fargo

Doing business as Sanford Medical Center Fargo-IP Rehab Unit

  • Rehabilitation Hospital Unit
  • Fargo, ND
National Provider Identifier
1285795450
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
5068A Issued in ND
Legal business name
SANFORD MEDICAL CENTER FARGO
Doing business as
Sanford Medical Center Fargo-IP Rehab Unit
Practice address
1720 University Dr S
Fargo, ND 58103-4940
Phone
(701) 234-8700
NPI assigned
Dec 12, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 5068A ND Primary

Addresses

Primary practice location

1720 University Dr S
Fargo, ND 58103-4940

Mailing address

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

Other identifiers 6

IdentifierTypeStateIssuer
003152OtherNDBC
01821MedicaidND
0230050MedicaidSD
1029817OtherPREFERRED ONE
1C35HMEOtherMNBC
735547501MedicaidMN

Other names 1

  • Sanford Medical Center Fargo-IP Rehab Unit 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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091202000642 ND Part A Provider - Hospital 8426967803 Practice locations: Fargo, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285795450. Details of each certification follow.

Hospital certification: CCN 35T011

Legal name
SANFORD MEDICAL CENTER FARGO
Doing business as
SANFORD FARGO REHABILITATION
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1949 in ND
Enrollment address
1720 University Dr S
Fargo, ND 58103-4940
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Sanford Health SystemCCN 35T011 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 2016

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 24

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

View all 24

Ownership & related parties

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 DirectorTrustee Jan 1, 2017
Marnie Lynn Ventling-Herrmann Individual Corporate OfficerVice Chair Person Jan 1, 2024
Corporate DirectorTrustee Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP, Chief Revenue Cylce Officer Jan 19, 2020
Brent Gerard Teiken Individual Corporate DirectorTrustee Jul 3, 2012
Susan Drake Jarvis Individual W-2 Managing EmployeeCoo Fargo Jan 1, 2023
Kristin Kaye Herrmann Individual W-2 Managing Employee 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 OfficerSecretary Jan 1, 2024
Corporate DirectorTrustee Jan 1, 2017
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerCeo Nov 24, 2020
Corporate DirectorTrustee Nov 24, 2020
Douglas Marlin Griffin Individual W-2 Managing EmployeeChief Physician Fargo Sep 25, 2022
George Joseph Brown Individual Corporate OfficerTreasurer Jan 1, 2025
Corporate DirectorTrustee 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%
Tiffany L Lawrence Individual Corporate OfficerPresident Mar 3, 2022
W-2 Managing EmployeePresident Mar 3, 2022
Thomas Richard Wenzel Individual Corporate DirectorTrustee Jan 1, 2025
David Jonathan Shulkin Individual Corporate Director 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 OfficerChair Person Jan 1, 2024
Corporate DirectorTrustee 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 4

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.

Affiliated clinicians 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1285795450",
    "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": "1720 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-234-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD MEDICAL CENTER FARGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "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": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "ND",
            "license": "5068A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBC",
            "identifier": "003152",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01821",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230050",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1029817",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBC",
            "identifier": "1C35HME",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "735547501",
            "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 Medical Center Fargo-IP Rehab Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.