NPIMap

Organization Active NPI

Sanford Health Network

Doing business as Sanford Clinic Hartley

  • Family Medicine Physician
  • Hartley, IA
National Provider Identifier
1821270679
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANFORD HEALTH NETWORK
Doing business as
Sanford Clinic Hartley
Practice address
512 3Rd St NE
Hartley, IA 51346-1204
Phone
(712) 728-2702
Fax
(712) 728-2138
NPI assigned
Dec 4, 2007
Last updated
Nov 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

512 3Rd St NE
Hartley, IA 51346-1204

Mailing address

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

Other practice location 1

610 N Eastern St
Sanborn, IA 51248-1089
Phone (712) 728-2702

Other identifiers 2

IdentifierTypeStateIssuer
0254656OtherIAIOWA MEDICAID
0638593OtherIAIOWA MEDIPASS

Other names 1

  • Sanford Clinic Hartley Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324000654 IA Part B Supplier - Clinic/Group Practice 6800707100 Receives reassigned benefits from 72 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sanborn, IA; Sheldon, IA; Sibley, IA; Primghar, IA; Rock Rapids, IA; Boyden, IA; Hartley, IA; Lake Park, IA…

Other NPIs on the same Medicare enrollment 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0928425Sanford Clinic Hartley512 Third Street NE, Hartley, IA 51346Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1821270679",
    "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": "512 3RD ST NE",
            "city": "HARTLEY",
            "state": "IA",
            "postal_code": "513461204",
            "telephone_number": "712-728-2702",
            "fax_number": "712-728-2138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 N Eastern St",
            "address_purpose": "LOCATION",
            "city": "Sanborn",
            "state": "IA",
            "postal_code": "512481089",
            "country_code": "US",
            "telephone_number": "712-728-2702",
            "fax_number": "712-728-2138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA MEDICAID",
            "identifier": "0254656",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA MEDIPASS",
            "identifier": "0638593",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sanford Clinic Hartley",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Clinic Hartley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hartley, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.