NPIMap

Organization Active NPI

Sanford Health Network

Doing business as Sanford Clinic Canby

  • Rural Health Clinic/Center
  • Canby, MN
National Provider Identifier
1437243607
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SANFORD HEALTH NETWORK
Doing business as
Sanford Clinic Canby
Practice address
112 Saint Olaf Ave S
Canby, MN 56220-1433
Phone
(507) 223-7221
Fax
(507) 223-7886
NPI assigned
Oct 3, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

112 Saint Olaf Ave S
Canby, MN 56220-1433

Mailing address

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

Other identifiers 6

IdentifierTypeStateIssuer
106642OtherUCARE
367717600MedicaidMN
5100235OtherMEDICA
60171OtherHEALTH PARTNERS
01014223OtherPREFERRED ONE
5D82SIOtherBLUE CROSS

Other names 1

  • Sanford Clinic Canby Doing business as

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 SD, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031111000266 SD Part B Supplier - Clinic/Group Practice 6800707100 Receives reassigned benefits from 489 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ipswich, SD; Webster, SD; Vermillion, SD; Sioux Falls, SD; Kimball, SD; Clear Lake, SD; Chamberlain, SD; Canton, SD…
O20040715001116 MN Part B Supplier - Clinic/Group Practice 6800707100 Receives reassigned benefits from 308 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Windom, MN; Worthington, MN; Westbrook, MN; Walnut Grove, MN; Tracy, MN; Slayton, MN; Mountain Lake, MN; Lakefield, MN…
O20070807000845 MN Part A Provider - Rural Health Clinic 6800707100 Practice locations: Canby, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437243607. Details of each certification follow.

Rural health clinic certification: CCN 243411

Legal name
SANFORD HEALTH NETWORK
Doing business as
SANFORD CLINIC CANBY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 1998
Last certification
Jul 5, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1985 in SD
Enrollment address
112 Saint Olaf Ave S
Canby, MN 56220-1433
Related CCNs
241347

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 33

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

View all 33

National Provider Directory

National Provider Directory

Locations

1430 North Hwy
Jackson, MN 56143
Phone (507) 847-2200

Ownership & related parties

All disclosed owners & managing parties 17

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 DirectorBoard Member Dec 4, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate DirectorDirector Jan 1, 2022
Tony Lee Morrison Individual Corporate Director Feb 1, 1991
W-2 Managing EmployeeSr. Executive Director Feb 1, 1991
James Edward Cain Individual Corporate DirectorBoard Member Nov 19, 2015
Karin Louise Dulski Individual W-2 Managing EmployeeDirector, Revenue Management Nov 19, 2012
Brent Gerard Teiken Individual Corporate DirectorBoard Member Dec 4, 2014
Jolyn Joy Munson Individual W-2 Managing EmployeeSr. Director of PFS Feb 25, 2013
William D Marlette Individual Corporate OfficerCfo Jun 16, 2023
W-2 Managing EmployeeCfo Jun 16, 2023
Andrew Stewart North Individual Corporate DirectorBoard Member Jan 1, 2017
Stephanie Marie Swenson Individual W-2 Managing EmployeeDirector, Insurance Nov 1, 2019
William Joseph Gassen Individual Corporate OfficerPresident and Ceo Nov 24, 2020
Corporate DirectorPresident and Ceo Nov 24, 2020
W-2 Managing EmployeePresident and Ceo Nov 24, 2020
Wesley Owen Engbrecht Individual Corporate DirectorBoard of Trustes Jan 1, 2021
Sanford Organization, Fargo, ND Non-profit 5% Or Greater Indirect Ownership Interest Nov 2, 2009 100%
Donald Darwin Jacobs Individual Corporate DirectorBoard Member Dec 4, 2014
Sanford Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Apr 18, 2007 100%
Neil Leslie Gulsvig Individual Corporate Director Mar 28, 2019
Lauris Nelson Molbert Individual Corporate DirectorBoard of Trustees Jan 1, 2021

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Prairie Lakes Health Care System IncWatertown, SD, CCN 430005A Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2025
Windom Area HealthWindom, MN, CCN 241332 Hospital Operational/Managerial Control Jun 1, 1989
Windom Area HealthWindom, MN, CCN 24Z332 Hospital Operational/Managerial Control Jun 1, 1989
Sanford Webster Medical CenterBristol, SD, CCN 435093 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2000
Apr 7, 2025
Prairie Lakes Home HealthWatertown, SD, CCN 437019 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2025
Prairie Lakes HospiceWatertown, SD, CCN 431504 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2025

Facilities with the same owner 50

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 50

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1437243607",
    "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": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 SAINT OLAF AVE S",
            "city": "CANBY",
            "state": "MN",
            "postal_code": "562201433",
            "telephone_number": "507-223-7221",
            "fax_number": "507-223-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-01",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "106642",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "367717600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5100235",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "60171",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "01014223",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5D82SI",
            "state": null
        }
    ],
    "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 Clinic Canby",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Canby",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canby, MN

Sources for this page

Verify at the official NPI Registry.