Active NPI
Sanford Clinic
- Diagnostic Radiology Physician
- Sioux Falls, SD
National Provider Identifier
1487840237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- SANFORD CLINIC
- Practice address
- 5019 S Western Ave
Sioux Falls, SD 57108 - Phone
- (605) 328-5244
- Fax
- (605) 328-2867
- NPI assigned
- Sep 14, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Steve Goetsch
- Title
- Cfo
- Phone
- (605) 328-6940
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | |||
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
5019 S Western Ave
Sioux Falls, SD 57108
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CH8874 | Other | RR MEDICARE |
Other names 1
- Sanford Clinic Breast Health Institute
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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, IA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000532 | SD | Part B Supplier - Clinic/Group Practice | 0244143824 |
Receives reassigned benefits from 941 practitioners This NPI is an additional NPI on the enrollment |
| O20040216001158 | IA | Part B Supplier - Clinic/Group Practice | 0244143824 |
Receives reassigned benefits from 66 practitioners 25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sheldon, IA; Sioux City, IA; Rock Rapids, IA; Orange City, IA; Inwood, IA; Hawarden, IA |
Other NPIs on the same Medicare enrollment 24
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Worthington, MN
- NPI 1033423322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189728000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701043200000",
"number": "1487840237",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5019 S WESTERN AVE",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "57108",
"telephone_number": "605-328-5244",
"fax_number": "605-328-2867"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SANFORD CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-14",
"last_updated": "2023-11-27",
"status": "A",
"authorized_official_last_name": "GOETSCH",
"authorized_official_first_name": "STEVE",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "605-328-6940"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Radiation Oncology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CH8874",
"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 Breast Health Institute",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sanford Clinic Breast Health Institute",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sioux Falls, SD
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.