Sanford Clinic North

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SANFORD CLINIC NORTH

Doing business as

Sanford Bemidji 1705 Anne St. Clinic

Practice address

1705 Anne St NW
Bemidji, MN 56601-6151

Phone

(218) 333-5000

Fax

(218) 333-4766

NPI assigned

Jul 8, 2006

Last updated

Nov 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Martha K Leclerc

Title

VP

Phone

(701) 234-6248

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Sanford Bemidji 1705 Anne St. Clinic Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1386677870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016151",
            "telephone_number": "218-333-5000",
            "fax_number": "218-333-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016151",
            "telephone_number": "218-333-5000",
            "fax_number": "218-333-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD CLINIC NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "LECLERC",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "701-234-6248"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410013100",
            "state": "MN"
        }
    ],
    "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 Bemidji 1705 Anne St. Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Bemidji 1705 Anne St. Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Susanna Salter, MD
• Alexandria Fern Sand, MS, LAT, ATC
• Rachel Leigh Sanders, FNP-BC
• Sanford Clinic North (Sanford Bemidji 1611 Anne St. Clinic)
• Sanford Clinic North
• Sanford Clinic North (Sanford Bemidji East Clinic)
• Sanford Clinic North (Sanford Bemidji Orthopedic Clinic)
• Sanford Clinic North
• Sanford Health of Northern Minnesota (Sanford Health Occupational Medicine Clinic)
• Sanford Health of Northern Minnesota (Sanford Pharmacy 1611 Anne St)

• Family Medicine Physician in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.