NPIMap

Organization Active NPI

Sanford Health Network

  • Rural Health Clinic/Center
  • Clear Lake, SD
National Provider Identifier
1720129638
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
Practice address
701 3Rd Ave S
Clear Lake, SD 57226-2016
Phone
(605) 874-8484
Fax
(605) 874-3529
NPI assigned
Feb 12, 2007
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

701 3Rd Ave S
Clear Lake, SD 57226-2016

Mailing address

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

Other names 1

  • Sanford Clear Lake Clinic 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 SD2 enrollments

Enrollment records 2

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…
O20070716000764 SD Part A Provider - Rural Health Clinic 6800707100 2 other NPIs on this enrollment
Practice locations: Clear Lake, SD

Rural health clinic certification: CCN 433403

Legal name
SANFORD HEALTH NETWORK
Doing business as
SANFORD CLEAR LAKE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 1999
Last certification
Mar 18, 2024
Ownership / control type
2B
Most recent change of ownership
Jan 2, 1999 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1985 in SD
Enrollment address
701 3Rd Ave S
Clear Lake, SD 57226-2016
Related CCNs
431307

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

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

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 OfficerSr. Exec. Director, Revenue Cycle Aug 5, 2019
W-2 Managing EmployeeSr. Executive Director, Revenue Cyc 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 of Trustees Dec 4, 2014
Jolyn Joy Munson Individual W-2 Managing EmployeeDirector, Insurance Feb 25, 2013
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 Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 2, 2009 100%
Donald Darwin Jacobs Individual Corporate DirectorBoard Member Dec 4, 2014
Michelle Ann Bruhn Individual Corporate OfficerVP, Treasurer, Cfo Dec 2, 2021
W-2 Managing EmployeeVP, Treasurer, Cfo Dec 2, 2021
Sanford Health Organization, Sioux Falls, SD Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 18, 1997 100%
Neil Leslie Gulsvig Individual Corporate DirectorBoard of Trustees 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

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 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1720129638",
    "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": "701 3RD AVE S",
            "city": "CLEAR LAKE",
            "state": "SD",
            "postal_code": "572262016",
            "telephone_number": "605-874-8484",
            "fax_number": "605-874-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-06",
        "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": [],
    "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 Clear Lake Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clear Lake, SD

Sources for this page

Verify at the official NPI Registry.