NPIMap

Organization Active NPI

Sanford Health Network

Doing business as Sanford Jackson Medical Center

  • Critical Access Hospital
  • Jackson, MN
National Provider Identifier
1811901531
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
331670 Issued in MN
Legal business name
SANFORD HEALTH NETWORK
Doing business as
Sanford Jackson Medical Center
Practice address
1430 North Hwy
Jackson, MN 56143-1093
Phone
(507) 847-2420
Fax
(507) 847-3728
NPI assigned
Jul 28, 2006
Last updated
Feb 3, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SANFORD HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 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
Critical Access Hospital 282NC0060X 331670 MN Primary

Addresses

Primary practice location

1430 North Hwy
Jackson, MN 56143-1093

Mailing address

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

Other names 1

  • Sanford Jackson Medical Center 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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070716000359 MN Part A Provider - Critical Access Hospital 6800707100 Practice locations: Jackson, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811901531. Details of each certification follow.

Hospital certification: CCN 24Z315

Legal name
SANFORD HEALTH NETWORK
Doing business as
SANFORD JACKSON MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1985 in SD
Enrollment address
1430 North Hwy
Jackson, MN 56143-1093
Other Hospital Practice Location

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

National Provider Directory

National Provider Directory
Tax ID family
Olson Medical Clinic49 organizations share this tax ID, including this one
Part of
Olson Medical Clinic

Other organizations with this tax ID 48

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

View all 48

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

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 Cycle Nov 19, 2012
Brent Gerard Teiken Individual Corporate DirectorBoard Member Dec 4, 2014
Jolyn Joy Munson Individual W-2 Managing EmployeeDirector Insurance Feb 25, 2013
Dana James Dykhouse Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew Stewart North Individual Corporate DirectorBoard Member Dec 1, 2016
Stephanie Marie Swenson Individual W-2 Managing EmployeeDirector, Insurance Nov 1, 2019
Stephanie Marie Herseth Sandlin Individual Corporate DirectorBoard Member Jan 1, 2024
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 Trustes Jan 1, 2021
Sanford Organization, Fargo, ND Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 2, 2009 100%
David Jonathan Shulkin Individual Corporate DirectorBoard Member Jan 1, 2024
Sanford Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Jun 8, 2007 100%
Neil Leslie Gulsvig Individual Corporate DirectorBoard Member Mar 28, 2019
Lauris Nelson Molbert Individual Corporate DirectorBoard of Trustees Jan 1, 2021
Nicholas Wayne Olson Individual Corporate OfficerEvp, Chief Financial Officer Apr 8, 2024
W-2 Managing EmployeeEvp, Chief Financial Officer Apr 8, 2024

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

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1811901531",
    "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": "1430 NORTH HWY",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431093",
            "telephone_number": "507-847-2420",
            "fax_number": "507-847-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANFORD HEALTH NETWORK",
        "enumeration_date": "2006-07-28",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "331670",
            "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 Jackson Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MN

Sources for this page

Verify at the official NPI Registry.