NPIMap

Organization Active NPI

Sanford Health Network

Doing business as Sanford Clinic Mountain Lake

  • Rural Health Clinic/Center
  • Mountain Lake, MN
National Provider Identifier
1568469039
Registry record updated Mar 12, 2026
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 Mountain Lake
Practice address
308 8TH St N
Mountain Lake, MN 56159-1568
Phone
(507) 427-3332
Fax
(507) 831-0135
NPI assigned
Jun 30, 2005
Last updated
Mar 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

308 8TH St N
Mountain Lake, MN 56159-1568

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
958132400MedicaidMN

Other names 1

  • Sanford Clinic Mountain Lake 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 MN, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20230104003082 TN Part A Provider - Rural Health Clinic 6800707100 Practice locations: Mountain Lake, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568469039. Details of each certification follow.

Rural health clinic certification: CCN 243831

Legal name
SANFORD HEALTH NETWORK
Doing business as
SANFORD CLINIC MOUNTAIN LAKE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 2, 1995
Last certification
Sep 23, 2014
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2001 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
308 8TH St N
Mountain Lake, MN 56159-1568

Other NPIs on the same Medicare enrollment 15

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

View all 15

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
24D0405271Sanford Health - Mountain Lake Clinic308 North 8TH Street, Mountain Lake, MN 56159Certificate of waiverDec 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Canby Community Health49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

303 E Jefferson St
Inwood, IA 51240
Phone (712) 753-4401

118 N 7th Ave
#250
Sheldon, IA 51201
Phone (712) 324-5041

801 3rd St
Currie, MN 56123
Phone (507) 629-3520

211 E Main St
Ste 101
Luverne, MN 56156
Phone (507) 283-1805

2170 Hospital Dr
Windom, MN 56101
Phone (507) 831-1422

3015 3rd Ave SE
Ste 100
Aberdeen, SD 57401
Phone (605) 226-5500

606 W Cedar St
Beresford, SD 57004
Phone (605) 763-2048

1210 W 18th St
Ste LL03
Sioux Falls, SD 57104
Phone (605) 328-1410

1309 W 17th St
Ste 101
Sioux Falls, SD 57104
Phone (605) 328-8000

1500 W 22nd St
Ste 101
Sioux Falls, SD 57105
Phone (605) 328-0000

1201 Mickelson Dr
Ste 1
Watertown, SD 57201
Phone (605) 882-2630

Ownership & related parties

All disclosed owners & managing parties 21

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 Director Dec 4, 2014
Maria Caroline Bell Individual Corporate Director Dec 4, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate DirectorDirector Jan 1, 2022
Tony Lee Morrison Individual Corporate OfficerVP, Revenue Cycle Feb 1, 1991
W-2 Managing EmployeeVP, Revenue Cycle Feb 1, 1991
James Edward Cain Individual Corporate Director Nov 19, 2015
Karin Louise Dulski Individual W-2 Managing Employee Dec 19, 2012
Sanford Organization, Fargo, ND Non-profit 5% Or Greater Indirect Ownership Interest Nov 2, 2009 100%
Mark Roger Paulson Individual Corporate OfficerBoard Member Nov 9, 2012
Corporate DirectorBoard Member Nov 2, 2009
Brent Gerard Teiken Individual Corporate OfficerBoard Member Nov 9, 2012
Jolyn Joy Munson Individual W-2 Managing EmployeeSr.Director of PFS Feb 25, 2013
Andrew Stewart North Individual Corporate Director Jan 1, 2017
Stephanie Marie Swenson Individual W-2 Managing EmployeeDirector Nov 1, 2019
Michelle Marie Micka Individual Corporate OfficerSenior VP Finance Jan 6, 2019
W-2 Managing EmployeeSenior VP Finance Jan 6, 2019
William Joseph Gassen Individual Corporate OfficerPresident & Ceo Nov 24, 2020
Corporate DirectorPresident & Ceo Nov 24, 2020
W-2 Managing EmployeePresident & Ceo Nov 24, 2020
Wesley Owen Engbrecht Individual Corporate DirectorBoard of Trustees Jan 1, 2021
Donald Darwin Jacobs Individual Corporate Director Dec 4, 2014
Michelle Ann Bruhn Individual Corporate OfficerVP,Cfo,Treasurer Dec 2, 2021
W-2 Managing EmployeeVP,Cfo,Treasurer Feb 2, 2021
Sanford Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Aug 10, 2007 100%
Neil Leslie Gulsvig Individual Corporate Director Mar 28, 2019
Lauris Nelson Molbert Individual Corporate DirectorBoard of Trustees Jan 1, 2021
Robin Lisa Smith Individual Corporate DirectorBoard of Trustees Jan 1, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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 65

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

View all 65

Practitioners & affiliated clinicians

Practitioners 718

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 718

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1568469039",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 8TH ST N",
            "city": "MOUNTAIN LAKE",
            "state": "MN",
            "postal_code": "561591568",
            "telephone_number": "507-427-3332",
            "fax_number": "507-831-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "958132400",
            "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",
            "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 Clinic Mountain Lake",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Mountain Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Lake, MN

Sources for this page

Verify at the official NPI Registry.