NPIMap

Organization Active NPI

Sanford Health of Northern Minnesota

Doing business as Sanford Bemidji Hospice

  • Community Based Hospice Care Agency
  • Bemidji, MN
National Provider Identifier
1730292178
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SANFORD HEALTH OF NORTHERN MINNESOTA
Doing business as
Sanford Bemidji Hospice
Practice address
3201 Pine Ridge Ave NW
Suite a
Bemidji, MN 56601-5101
Phone
(218) 333-5665
Fax
(218) 333-5642
NPI assigned
Aug 17, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SANFORD HEALTH OF NORTHERN MINNESOTAAs reported in NPPES

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
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

3201 Pine Ridge Ave NW
Suite a
Bemidji, MN 56601-5101

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
1014013OtherPREFERRED ONE
3Z05NOOtherMNBLUE CROSS BLUE SHIELD MN
5025411OtherMEDICA
890713700MedicaidMN

Other names 1

  • Sanford Bemidji Hospice 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 MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100820000664 MN Part A Provider - Hospice 5597725168 Practice locations: Bemidji, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730292178. Details of each certification follow.

Hospice certification: CCN 241511

Legal name
SANFORD HEALTH OF NORTHERN MINNESOTA
Doing business as
SANFORD BEMIDJI HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 23, 1987
Last certification
Jun 6, 2019
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Nov 11, 1975 in MN
Enrollment address
3201 Pine Ridge Ave NW
Ste a
Bemidji, MN 56601-5101

Other NPIs with the same Medicare PAC ID 20

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 20

Care Compare: Hospice

Medicare Care Compare
Listed as
Sanford Bemidji HospiceCCN 241511 · All quality measures
Ownership
Non-Profit
Certified
Jun 23, 1987
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Sanford Health of N MN23 organizations share this tax ID, including this one
Part of
Sanford Health of N MN

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 26

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 DirectorTrustee Dec 4, 2014
Jason Joseph Caron Individual W-2 Managing EmployeePresident Jan 1, 2026
Marnie Lynn Ventling-Herrmann Individual Corporate DirectorTrustee Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP Chief Revenue Cycle Officer Jan 19, 2020
Ashley Gagola Individual W-2 Managing EmployeeAd; Jun 1, 2025
Daniel George Hoody Individual W-2 Managing EmployeeChief Physician & Medical Officer Oct 9, 2023
Brent Gerard Teiken Individual Corporate DirectorTrustee Jul 3, 2012
Jolyn Joy Munson Individual W-2 Managing EmployeeVP Revenue Cycle Operations Apr 17, 2025
Dana James Dykhouse Individual Corporate DirectorTrustee Jan 1, 2024
Andrew Stewart North Individual Corporate DirectorTrustee Jan 1, 2017
Renee Marie Axtman Individual W-2 Managing EmployeeChief Operations Officer Jan 1, 2026
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate DirectorCeo, Trustee Nov 23, 2020
George Joseph Brown Individual Corporate DirectorTrustee Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorBoard of Trustes Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND Non-profit 5% Or Greater Indirect Ownership Interest May 1, 2013 100%
Jamie Jo Sindelar Individual W-2 Managing EmployeeMD; Oct 13, 2025
Lisa Sue Miller Individual W-2 Managing EmployeeChief Financial Officer Sep 9, 2019
Thomas Richard Wenzel Individual Corporate DirectorTrustee Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorTrustee Jan 1, 2024
Neil Leslie Gulsvig Individual Corporate DirectorTrustee Mar 28, 2019
Kevin Victor Schieffer Individual Corporate DirectorTrustee Jan 1, 2025
Lauris Nelson Molbert Individual Corporate DirectorTrustee Jan 1, 2021
Nicholas Wayne Olson Individual W-2 Managing EmployeeChief Financial Officer Apr 8, 2024
Sanford North Organization, Bismarck, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2011 100%

Owners & managing parties with NPI records 3

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

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 20

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1730292178",
    "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": "3201 PINE RIDGE AVE NW",
            "address_2": "SUITE A",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015101",
            "telephone_number": "218-333-5665",
            "fax_number": "218-333-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "enumeration_date": "2006-08-17",
        "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": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1014013",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "3Z05NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5025411",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890713700",
            "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",
            "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 Bemidji Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Bemidji Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bemidji, MN

Sources for this page

Verify at the official NPI Registry.