Individual provider Active NPI

Jonathan Robert Sande, MD

  • Hematology & Oncology Physician
  • Cloquet, MN
National Provider Identifier
1316970536
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
36412 Issued in MN
Practice address
512 Skyline Blvd Ste 1
Cloquet, MN 55720-1199
Phone
(218) 879-4641
NPI assigned
Jul 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) Physician 207RH0000X 36412 MN
Medical Oncology Physician 207RX0202X 36412 MN
Hematology & Oncology Physician 207RH0003X 36412 MN Primary

Addresses

Primary practice location

512 Skyline Blvd Ste 1
Cloquet, MN 55720-1199

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

1233 34th St NW
Bemidji, MN 56601-5112
Phone (218) 333-5522

Other identifiers 2

IdentifierTypeStateIssuer
32448000MedicaidWI
085525100MedicaidMN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hisdept@direct.cloquethospital.com
Direct Messaging Address jsande678337@direct.centracare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060223000160 MN Practitioner - Hematology/OncologyPractitioner - Internal Medicine 2163438433 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Mayo Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Memorial Hospital AssociationGroup PAC ID 0042129991, 47 clinicians

Practice addresses (Care Compare)

512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641

Hospital & facility affiliations

  • Community Memorial Hospital Hospital, Cloquet, MN, CCN 241364
  • Wilcox Memorial Hospital Hospital, Lihue, HI, CCN 120014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36412MNMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Hospital Association CurrentSince Jun 1, 2024 Accepting new patients
Carris Health LLC CurrentSince Feb 1, 2023 Accepting new patients
Kauai Medical Clinic CurrentSince Jan 20, 2024 Accepting new patients
Kauai Medical Clinic CurrentSince Jan 20, 2024 Accepting new patients
Carris Health LLC Hematology & Oncology CurrentSince Feb 1, 2023 Accepting new patients
Community Memorial Hospital Association PastSince Jun 30, 2024 Accepting new patients

Locations

3-3420 Kuhio Hwy
Ste B
Lihue, HI 96766
Phone (808) 245-1500

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

512 Skyline Blvd
Ste 1
Cloquet, MN 55720
Phone (218) 879-4641

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

Interoperability endpoints

  • Direct secure messaging: jsande678337@direct.centracare.com
  • Direct secure messaging: hisdept@direct.cloquethospital.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1316970536",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD STE 1",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1233 34th St NW",
            "address_purpose": "LOCATION",
            "city": "Bemidji",
            "state": "MN",
            "postal_code": "566015112",
            "country_code": "US",
            "telephone_number": "218-333-5522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDE",
        "first_name": "JONATHAN",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "MN",
            "license": "36412",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MN",
            "license": "36412",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MN",
            "license": "36412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32448000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085525100",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hisdept@direct.cloquethospital.com",
            "affiliation": "N",
            "address_1": "512 Skyline Blvd Ste 1",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsande678337@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jsande678337@direct.centracare.com",
            "address_1": "301 Becker Ave SW",
            "city": "Willmar",
            "state": "MN",
            "country_code": "US",
            "postal_code": "562013302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.