NPIMap

Organization Active NPI

Sanford Clinic

Doing business as Sanford Health Psychiatry & Psychology Clinic

  • Psychologist
  • Sioux Falls, SD
National Provider Identifier
1396764254
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
SANFORD CLINIC
Doing business as
Sanford Health Psychiatry & Psychology Clinic
Practice address
2400 W 49TH St
Sioux Falls, SD 57105-6581
Phone
(605) 312-8700
Fax
(605) 312-8701
NPI assigned
Jul 19, 2006
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Psychologist 103T00000X Primary
Psychiatry Physician 2084P0800X
Child & Adolescent Psychiatry Physician 2084P0804X

Addresses

Primary practice location

2400 W 49TH St
Sioux Falls, SD 57105-6581

Mailing address

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

Other practice location 1

922 22nd Ave S
Brookings, SD 57006-2830
Phone (605) 312-8700

Other practice location 2

6110 S Minnesota Ave
Sioux Falls, SD 57108-2549
Phone (605) 312-8700

Other practice location 3

2501 W 26th St
Sioux Falls, SD 57105-2446
Phone (605) 312-8700

Other practice location 4

4100 S Western Ave
Sioux Falls, SD 57105-6620
Phone (605) 444-9900

Other identifiers 2

IdentifierTypeStateIssuer
682698900MedicaidMN
0537886MedicaidIA

Other names 1

  • Sanford Health Psychiatry & Psychology Clinic Doing business as

Electronic endpoints 1

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000532 SD Part B Supplier - Clinic/Group Practice 0244143824 Receives reassigned benefits from 941 practitioners

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D2036754Sanford Health Pyschiatry & Psychology Clinic2400 West 49TH Street, Sioux Falls, SD 57105Certificate of waiverFeb 12, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Luther Memorial HomeMayville, ND, CCN 355040 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 1, 2020
Aug 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 961

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 961

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1396764254",
    "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",
            "fax_number": "605-328-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W 49TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056581",
            "telephone_number": "605-312-8700",
            "fax_number": "605-312-8701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "922 22nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Brookings",
            "state": "SD",
            "postal_code": "570062830",
            "country_code": "US",
            "telephone_number": "605-312-8700",
            "fax_number": "605-312-8701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6110 S Minnesota Ave",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571082549",
            "country_code": "US",
            "telephone_number": "605-312-8700",
            "fax_number": "605-312-8707",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2501 W 26th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571052446",
            "country_code": "US",
            "telephone_number": "605-312-8700",
            "fax_number": "605-312-8701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4100 S Western Ave",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571056620",
            "country_code": "US",
            "telephone_number": "605-444-9900",
            "fax_number": "605-444-9902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "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": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "682698900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0537886",
            "state": "IA"
        }
    ],
    "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",
            "affiliationName": "Cobius Healthcare Solutions",
            "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 Psychiatry & Psychology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.