Sanford Clinic North

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SANFORD CLINIC NORTH

Doing business as

Sanford Bemidji East Clinic

Practice address

3604 Bemidji Ave N
Bemidji, MN 56601-4333

Phone

(218) 333-5111

Fax

(218) 333-5458

NPI assigned

Jul 25, 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 2

Addresses

Other identifiers 1

Other names 1

• Sanford Bemidji East Clinic Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1407878424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 BEMIDJI AVE N",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566014333",
            "telephone_number": "218-333-5111",
            "fax_number": "218-333-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 BEMIDJI AVE N",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566014333",
            "telephone_number": "218-333-5111",
            "fax_number": "218-333-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD CLINIC NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "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": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194342100",
            "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 East Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Bemidji East Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexandria Fern Sand, MS, LAT, ATC
• Rachel Leigh Sanders, FNP-BC
• Sanford Clinic North (Sanford Bemidji 1611 Anne St. Clinic)
• Sanford Clinic North
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• Sanford Clinic North
• Sanford Health of Northern Minnesota (Sanford Health Occupational Medicine Clinic)
• Sanford Health of Northern Minnesota (Sanford Pharmacy 1611 Anne St)
• Sanford Health of Northern Minnesota (Sanford Health Primewest Residential Support Center)

• Dermatology Physician in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Dermatology 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.