NPIMap

Organization Active NPI

Sanford Clinic

Doing business as Sanford Clinic Watertown

  • Family Medicine Physician
  • Watertown, SD
National Provider Identifier
1801840632
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANFORD CLINIC
Doing business as
Sanford Clinic Watertown
Practice address
901 4TH St NW
Watertown, SD 57201-0290
Phone
(605) 886-8471
Fax
(605) 886-9317
NPI assigned
May 19, 2006
Last updated
Nov 27, 2023By the provider in NPPES
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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

901 4TH St NW
Watertown, SD 57201-0290

Mailing address

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

Other practice location 1

450 Eastvold Ave
Ortonville, MN 56278-1252
Phone (320) 839-6157

Other practice location 2

205 Orchard Dr
Sisseton, SD 57262-2312
Phone (605) 698-7681

Other practice location 3

401 9th Ave NW
Watertown, SD 57201-1548
Phone (605) 886-8471

Other practice location 4

922 22nd Ave S
Brookings, SD 57006-2830
Phone (605) 886-8471

Other practice location 5

300 22nd Ave
Brookings, SD 57006-2480
Phone (605) 886-8471

Other practice location 6

1401 W 1st St
Webster, SD 57274-1054
Phone (605) 345-4141

Other names 1

  • Sanford Clinic Watertown 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 SD, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000532 SD Part B Supplier - Clinic/Group Practice 0244143824 Receives reassigned benefits from 941 practitioners
This NPI is an additional NPI on the enrollment
O20040115000943 MN Part B Supplier - Clinic/Group Practice 0244143824 Receives reassigned benefits from 113 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prior Lake, MN; Slayton, MN; Tracy, MN; Walker, MN; Windom, MN; Worthington, MN; Stillwater, MN; Luverne, MN…

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1801840632",
    "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": "901 4TH ST NW",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572010290",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Eastvold Ave",
            "address_purpose": "LOCATION",
            "city": "Ortonville",
            "state": "MN",
            "postal_code": "562781252",
            "country_code": "US",
            "telephone_number": "320-839-6157",
            "fax_number": "320-839-3851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 Orchard Dr",
            "address_purpose": "LOCATION",
            "city": "Sisseton",
            "state": "SD",
            "postal_code": "572622312",
            "country_code": "US",
            "telephone_number": "605-698-7681",
            "fax_number": "605-698-3493",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 9th Ave NW",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "SD",
            "postal_code": "572011548",
            "country_code": "US",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "922 22nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Brookings",
            "state": "SD",
            "postal_code": "570062830",
            "country_code": "US",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Brookings",
            "state": "SD",
            "postal_code": "570062480",
            "country_code": "US",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 W 1st St",
            "address_purpose": "LOCATION",
            "city": "Webster",
            "state": "SD",
            "postal_code": "572741054",
            "country_code": "US",
            "telephone_number": "605-345-4141",
            "fax_number": "605-312-8926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-07",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "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 Clinic Watertown",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Watertown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watertown, 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.

Verify at the official NPI Registry.