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Sanford Health Network North

Organization Active NPI Multi-Specialty Clinic/Center · Thief River Falls, MN

NPI 1386047355 · NPPES record last updated Nov 27, 2023

Key facts

NPI
1386047355
Entity type
Organization (NPI type 2)
Primary specialty
Multi-Specialty Clinic/Center 261QM1300X
Legal business name
SANFORD HEALTH NETWORK NORTH
Practice address
1720 Highway 59 S
Thief River Falls, MN 56701-4331
Phone
(218) 681-4747
Fax
(218) 683-2595
NPI assigned
Oct 3, 2014
Organization subpart
No

Authorized official

Name
Tony Lee Morrison
Title
Vice President, Revenue Cycle
Phone
(605) 328-8380

Other NPIs on the same Medicare enrollment 7

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

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 261

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 261

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180205002429 MN Part B Supplier - Clinic/Group Practice 8022206663 Receives reassigned benefits from 232 practitioners
7 other NPIs on this enrollment
Practice locations: Wheaton, MN; Ulen, MN; Thief River Falls, MN; Halstad, MN; Roseau, MN; Plymouth, MN; Pequot Lakes, MN; Moorhead, MN…

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist
Group: 193200000X MULTI-SPECIALTY GROUP		 103G00000X
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X
Allergy & Immunology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207K00000X
Dermatology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207N00000X
Ophthalmology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207W00000X
Audiologist
Group: 193200000X MULTI-SPECIALTY GROUP		 231H00000X
Multi-Specialty Clinic/Center 261QM1300X Yes

Addresses

Primary practice location

1720 Highway 59 S
Thief River Falls, MN 56701-4331

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Other names

  • Sanford Health Southeast Campus Doing business as
  • Sanford Health Thief River Falls Eye Center & Optical Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 27, 2023.

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1386047355",
    "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",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 HIGHWAY 59 S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014331",
            "telephone_number": "218-681-4747",
            "fax_number": "218-683-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-03",
        "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": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Southeast Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Health Thief River Falls Eye Center & Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thief River Falls, MN

All providers in Thief River Falls, MN · Multi-Specialty Clinic/Center in Minnesota

Sources for this page

Verify at the official NPI Registry.