NPIMap

Organization Active NPI

Sanford Health Network North

Doing business as Sanford Health Finley Clinic

  • Family Medicine Physician
  • Mayville, ND
National Provider Identifier
1366478760
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANFORD HEALTH NETWORK NORTH
Doing business as
Sanford Health Finley Clinic
Sanford Mayville
Practice address
600 1St St SE
Mayville, ND 58257-1518
Phone
(701) 788-4500
Fax
(701) 788-4545
NPI assigned
Jun 25, 2006
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Shannon Teeman
Title
Supervisor
Phone
(701) 234-1094

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Pediatrics Physician 208000000X

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 4

IdentifierTypeStateIssuer
15664MedicaidND
DR5473OtherNDRR MEDICARE
079016800MedicaidMN
15666MedicaidND

Other names 3

  • Sanford Health Finley Clinic Doing business as
  • Sanford Mayville Doing business as
  • Sanford Medical Center Mayville Former legal business name

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 ND2 enrollments

Enrollment records 2

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
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366478760. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 1, 2018 in ND
Enrollment address
42 6TH Ave SE
Mayville, ND 58257-1506
Other Hospital Practice Location

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 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sanford MayvilleCCN 351309 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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 & Ceo Nov 23, 2020
Corporate DirectorTrustee & Ceo 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 DirectorBoard of Trustes 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 DirectorTrustee 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 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.

Practitioners & affiliated clinicians

Practitioners 45

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 45

Affiliated clinicians 105

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

View all 105

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1366478760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 1ST ST SE",
            "city": "MAYVILLE",
            "state": "ND",
            "postal_code": "582571518",
            "telephone_number": "701-788-4500",
            "fax_number": "701-788-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 1ST ST SE",
            "city": "MAYVILLE",
            "state": "ND",
            "postal_code": "582571518",
            "telephone_number": "701-788-4500",
            "fax_number": "701-788-4545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 Washington Ave E",
            "address_purpose": "LOCATION",
            "city": "Finley",
            "state": "ND",
            "postal_code": "582307501",
            "country_code": "US",
            "telephone_number": "701-524-1005",
            "fax_number": "701-524-2027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "TEEMAN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "701-234-1094"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15664",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DR5473",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079016800",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15666",
            "state": "ND"
        }
    ],
    "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 Finley Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Mayville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Medical Center Mayville",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sanford Medical Center Mayville",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mayville, ND

Sources for this page

Verify at the official NPI Registry.