Sanford Health Network North
Organization Active NPI Family Medicine Physician · Mayville, ND
NPI 1366478760 · NPPES record last updated Jan 24, 2025
Key facts
- NPI
- 1366478760
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SANFORD HEALTH NETWORK NORTH
- Practice address
- 600 1St St SE
Mayville, ND 58257-1518 - Phone
- (701) 788-4500
- Fax
- (701) 788-4545
- NPI assigned
- Jun 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Shannon Teeman
- Title
- Supervisor
- Phone
- (701) 234-1094
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 15
Related certifications (CCN) 1
Practitioners 135
-
Charles J Breen, MD
-
Sugong Chen, M.D.
-
Gabriel Davidson, PA-C
-
Ellen Delores Vogels, D.O.
-
Abbey L Anderson, FNP-C
-
Christine Hanson, APRN, PMHNP-BC
-
Davis John Mills, DNP, PMHNP-BC
-
Mia M Kozojed, NP
-
Steven W Lantz, MD
-
James G Mehus, MD
-
John Paul Naughton, D.P.M.
-
Jane Ostlie, MD
-
Ann M Owens, PA-C
-
James Richard Pantel, PA-C
-
Christina E Torgerson, FNP-C
-
Brandee Danks, PA
-
Naomi Hass, LRD
Affiliated clinicians 105
-
Stephen Thomas Aldred, PA-C
-
Daniel Almquist, M.D.
-
Seth Anderson, DO
-
Jason M Asheim, M.D.
-
John Christopher Asleson, M.D.
-
Jason Balvitsch, PA-C
-
Andrea Marie Beiseker, FNP-BC
-
Ismail Loai Bekdash, M.D.
-
Kim Belzberg, M.D.
-
Molly Ann Berg, DNP, FNP
-
Joanna M. Breding, PA-C
-
Charles J Breen, MD
-
Amanda Jo Brown, PA-C
-
Sheila Diane Bullock, FNP-C
-
Sugong Chen, M.D.
-
David S Chou, MD
-
David J Clardy, MD
-
Benjamin Lane Dahl, M.D.
-
Kevin Dahl, MD
Medicare Care Compare: Hospital
- Listed as
- Sanford Mayville
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND
Hospital certification: CCN 351309
- Legal name
- SANFORD HEALTH NETWORK NORTH
- Doing business as
- SANFORD MEDICAL CENTER MAYVILLE
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Oct 1, 2000
- Last certification
- Sep 1, 2022
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 1, 2018 in ND
- Enrollment address
- 42 6TH Ave SE
Mayville, ND 58257-1506
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Allen Lundeen |
Corporate Director |
Dec 4, 2014 | |
| Marnie Lynn Ventling-Herrmann |
Corporate Officer |
Jan 1, 2024 | |
| Corporate Director |
Jan 1, 2022 | ||
| Tony Lee Morrison |
W-2 Managing Employee |
Jan 19, 2020 | |
| Brent Gerard Teiken |
Corporate Director |
Jul 3, 2012 | |
| Susan Drake Jarvis |
Corporate Officer |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 | ||
| Kristin Kaye Herrmann |
W-2 Managing Employee |
Apr 24, 2022 | |
| Jolyn Joy Munson |
W-2 Managing Employee |
Apr 17, 2025 | |
| Dana James Dykhouse |
Corporate Director |
Jan 1, 2024 | |
| Andrew Stewart North |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Jan 1, 2017 | ||
| Stephanie Marie Herseth Sandlin |
Corporate Director |
Jan 1, 2024 | |
| William Joseph Gassen |
Corporate Officer |
Nov 23, 2020 | |
| Corporate Director |
Nov 23, 2020 | ||
| Douglas Marlin Griffin |
W-2 Managing Employee |
Sep 25, 2022 | |
| George Joseph Brown |
Corporate Officer |
Jan 1, 2025 | |
| Corporate Director |
Jan 1, 2025 | ||
| Wesley Owen Engbrecht |
Corporate Director |
Jan 1, 2021 | |
| Maureen Patricia McCausland |
Corporate Director |
Jan 1, 2025 | |
| Sanford |
5% Or Greater Indirect Ownership Interest | Jul 20, 2010 | 100% |
| Thomas Richard Wenzel |
Corporate Director |
Jan 1, 2025 | |
| David Jonathan Shulkin |
Corporate Director |
Jan 1, 2024 | |
| Neil Leslie Gulsvig |
Corporate Director |
Mar 28, 2019 | |
| Kevin Victor Schieffer |
Corporate Director |
Jan 1, 2025 | |
| Lauris Nelson Molbert |
Corporate Officer |
Jan 1, 2024 | |
| Corporate Director |
Jan 1, 2021 | ||
| Nicholas Wayne Olson |
W-2 Managing Employee |
Apr 8, 2024 | |
| Sanford North |
5% Or Greater Direct Ownership Interest | Mar 1, 2011 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171226001068 | ND | Part B Supplier - Clinic/Group Practice | 8022206663 |
Receives reassigned benefits from 43 practitioners 4 other NPIs on this enrollment Practice locations: Thompson, ND; Mayville, ND; Hillsboro, ND; Grand Forks, ND; Finley, ND |
| O20180205001488 | ND | Part a Provider - Critical Access Hospital | 8022206663 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mayville, ND |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Pediatrics Physician |
208000000X | |||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
600 1St St SE
Mayville, ND 58257-1518
Mailing address
600 1St St SE
Mayville, ND 58257-1518
Phone (701) 788-4500
Other practice location 1
407 Washington Ave E
Finley, ND 58230-7501
Phone (701) 524-1005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15664 | Medicaid | ND | |
| 079016800 | Medicaid | MN | |
| 15666 | Medicaid | ND | |
| DR5473 | Other | ND | RR MEDICARE |
Other names
- Sanford Health Finley Clinic
- Sanford Mayville
- Sanford Medical Center Mayville
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other |
Other providers in Mayville, ND
- Jane Ostlie
- Tami K Parker
- Michael Kenneth Rexine
- Carolyn Rygg
- Sanford Health Network North
- Sanford Health Network North
- Mary Jo Slaathaug
- Matthew Alan Strand
- Union Hospital Soceity of Mayville ND
- Union Hospital Society of Mayvile ND
All providers in Mayville, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2025. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.