Sanford Clinic
Organization Active NPI Ophthalmology Physician · Sioux Falls, SD
NPI 1366468449 · NPPES record last updated Feb 22, 2021
Key facts
- NPI
- 1366468449
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- SANFORD CLINIC
- Practice address
- 1621 S Minnesota Ave
Sioux Falls, SD 57105-1743 - Phone
- (605) 328-9200
- Fax
- (605) 328-9201
- NPI assigned
- Jul 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Steve W Goetsch
- Title
- Cfo
- Phone
- (605) 328-6940
Other NPIs on the same Medicare enrollment 37
Practitioners 15
-
Bhargavi Ghanta, M.D
-
Dennis Glatt, MD
-
Stephanie M Ideker, PA-C
-
Rashmi Jain, MD
-
Aimee Louise Koenig, M.D.
-
Kelly Wiebenga, RDN
-
Kiran Poudel, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in SD, MN, IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000532 | SD | Part B Supplier - Clinic/Group Practice | 0244143824 |
Receives reassigned benefits from 941 practitioners This NPI is an additional NPI on the enrollment |
| O20040115000943 | MN | Part B Supplier - Clinic/Group Practice | 0244143824 |
Receives reassigned benefits from 113 practitioners 30 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Prior Lake, MN; Slayton, MN; Tracy, MN; Walker, MN; Windom, MN; Worthington, MN; Stillwater, MN; Luverne, MN… |
| O20040216001158 | IA | Part B Supplier - Clinic/Group Practice | 0244143824 |
Receives reassigned benefits from 66 practitioners 25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sheldon, IA; Sioux City, IA; Rock Rapids, IA; Orange City, IA; Inwood, IA; Hawarden, IA |
National Provider Directory
Locations
103 E Lawler Ave
Ste 1319
Chamberlain, SD 57325
Phone (605) 328-9200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | Yes |
Addresses
Primary practice location
1621 S Minnesota Ave
Sioux Falls, SD 57105-1743
Mailing address
1621 S Minnesota Ave
Sioux Falls, SD 57105-1743
Phone (605) 328-9200
Other practice location 1
1000 Lincoln Cir SE
Orange City, IA 51041-1836
Phone (712) 727-5241
Other practice location 2
103 E Lawler Ave Ste 1319
Chamberlain, SD 57325-1319
Phone (605) 328-9200
Other practice location 3
1401 1st St W
Webster, SD 57274-1054
Phone (605) 328-9200
Other practice location 4
101 Peabody Dr
Webster, SD 57274-1061
Phone (605) 328-9200
Other practice location 5
1436 E 10th St Ste 1
Winner, SD 57580-2874
Phone (605) 328-9200
Other practice location 6
745 E 8th St
Winner, SD 57580-2677
Phone (605) 328-9200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 281988100 | Medicaid | MN | |
| 0537886 | Medicaid | IA |
Other names
- Sanford Eye Center & Optical
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Sioux Falls, SD
- Sanford Clinic
- Sanford Clinic
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- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
All providers in Sioux Falls, SD · Ophthalmology Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.