NPIMap

Organization Active NPI

Sanford Bismarck

Doing business as Sanford Health Occupational Medicine Clinic

  • Occupational Medicine Clinic/Center
  • Dickinson, ND
National Provider Identifier
1669524351
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
License
261QX0100X Issued in ND
Legal business name
SANFORD BISMARCK
Doing business as
Sanford Health Occupational Medicine Clinic
Practice address
1531 W Villard St Ste a
Dickinson, ND 58601-4657
Phone
(701) 225-7575
NPI assigned
Jan 16, 2007
Last updated
Apr 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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
Occupational Medicine Clinic/Center 261QX0100X 261QX0100X ND Primary

Addresses

Primary practice location

1531 W Villard St Ste a
Dickinson, ND 58601-4657

Mailing address

2603 E Broadway Ave
Bismarck, ND 58501-5107
Phone (701) 323-8307

Other practice location 1

801 21st Ave SE
Minot, ND 58701-6064
Phone (701) 839-5902

Other practice location 2

2603 E Broadway Avenue
Bismarck, ND 58501
UM
Phone (701) 323-5222 ext. 5733

Other names 1

  • Sanford Health Occupational Medicine 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 ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000403 ND Part B Supplier - Clinic/Group Practice 9739098575 Receives reassigned benefits from 831 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mandan, ND; Dickinson, ND; Elgin, ND; Fargo, ND; Hettinger, ND; Jamestown, ND; Linton, ND; Williston, ND…

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

1531 W Villard St
Dickinson, ND 58601
Phone (701) 225-7575

515 E Broadway
Unit 5
Williston, ND 58801
Phone (701) 323-5631

Practitioners & affiliated clinicians

Practitioners 276

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 276

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1669524351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 E BROADWAY AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585015107",
            "telephone_number": "701-323-8307",
            "fax_number": "701-323-5867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 W VILLARD ST STE A",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014657",
            "telephone_number": "701-225-7575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 21st Ave SE",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587016064",
            "country_code": "US",
            "telephone_number": "701-839-5902",
            "fax_number": "701-839-5909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2603 E Broadway Avenue",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "58501",
            "country_code": "UM",
            "telephone_number": "701-323-5222 x5733",
            "fax_number": "701-323-5867",
            "country_name": "United States Minor Outlying Islands",
            "address_type": "FGN"
        }
    ],
    "basic": {
        "organization_name": "SANFORD BISMARCK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "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": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "ND",
            "license": "261QX0100X",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Occupational Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dickinson, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.

Verify at the official NPI Registry.