NPIMap

Organization Active NPI

Sanford Health Network North

Doing business as Sanford Behavioral Health Center Clinic

  • Multi-Specialty Clinic/Center
  • Thief River Falls, MN
National Provider Identifier
1861895906
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SANFORD HEALTH NETWORK NORTH
Doing business as
Sanford Behavioral Health Center Clinic
Practice address
120 Labree Ave S
Thief River Falls, MN 56701-2819
Phone
(218) 683-4351
Fax
(218) 681-5614
NPI assigned
Oct 3, 2014
Last updated
Jun 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

120 Labree Ave S
Thief River Falls, MN 56701-2819

Mailing address

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

Other practice location 1

1750 47th Ave S
Grand Forks, ND 58201-7222
Phone (701) 757-8700

Other practice location 2

929 Central Ave NW
East Grand Forks, MN 56721-1917
Phone (218) 773-6800

Other practice location 3

30679 Peaceful Point Rd
Bovey, MN 55709-5524
Phone (218) 683-4351

Other names 1

  • Sanford Behavioral Health Center Clinic 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 ND, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20171226001068 ND Part B Supplier - Clinic/Group Practice 8022206663 Receives reassigned benefits from 43 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thompson, ND; Mayville, ND; Hillsboro, ND; Grand Forks, ND; Finley, ND
O20180205002429 MN Part B Supplier - Clinic/Group Practice 8022206663 Receives reassigned benefits from 232 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wheaton, MN; Ulen, MN; Thief River Falls, MN; Halstad, MN; Roseau, MN; Plymouth, MN; Pequot Lakes, MN; Moorhead, MN…
O20180222001872 MN Part A Provider - Critical Access Hospital 8022206663 Receives reassigned benefits from 132 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thief River Falls, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861895906. Details of each certification follow.

Hospital certification: CCN 241381

Legal name
SANFORD HEALTH NETWORK NORTH
Doing business as
SANFORD THIEF RIVER FALLS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 31, 2005
Last certification
Apr 10, 2024
Beds
36 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2018 in ND
Enrollment address
3001 Sanford Pkwy
Thief River Falls, MN 56701-2700

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

Other NPIs on the same Medicare enrollment 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sanford Thief River Falls Medical CenterCCN 241381 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Sanford Health Network North14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 23

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 Nov 19, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate OfficerTrustee/Vice Chairperson Jan 1, 2024
Corporate DirectorTrustee/Vice Chairperson Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP, Revenue Cycle Jan 19, 2020
Brent Gerard Teiken Individual Corporate DirectorBoard Member Sep 1, 2010
Susan Drake Jarvis Individual Corporate OfficerPresident Jan 1, 2023
W-2 Managing EmployeePresident Jan 1, 2023
Kristin Kaye Herrmann Individual W-2 Managing EmployeeChief Financial Officer, Fargo Apr 24, 2022
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 OfficerTrustee/Secretary Jan 1, 2020
Corporate DirectorTrustee/Secretary Jan 1, 2017
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerTrustee/ Ceo Nov 24, 2020
Corporate DirectorTrustee/ Ceo Nov 24, 2020
Douglas Marlin Griffin Individual W-2 Managing EmployeeChief Physician, Fargo Sep 25, 2022
George Joseph Brown Individual Corporate OfficerTrustee/ Treasurer Jan 1, 2025
Corporate DirectorTrustee/ Treasurer Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorTrustee Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND 5% Or Greater Indirect Ownership Interest Mar 1, 2011 100%
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/Chairperson Jan 1, 2021
Nicholas Wayne Olson Individual W-2 Managing Employee 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 1

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

Practitioners & affiliated clinicians

Practitioners 41

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 41

Affiliated clinicians 168

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

View all 168

NPI Registry JSON

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

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1861895906",
    "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": "120 LABREE AVE S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012819",
            "telephone_number": "218-683-4351",
            "fax_number": "218-681-5614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 47th Ave S",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582017222",
            "country_code": "US",
            "telephone_number": "701-757-8700",
            "fax_number": "701-234-1147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 Central Ave NW",
            "address_purpose": "LOCATION",
            "city": "East Grand Forks",
            "state": "MN",
            "postal_code": "567211917",
            "country_code": "US",
            "telephone_number": "218-773-6800",
            "fax_number": "218-773-6861",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30679 Peaceful Point Rd",
            "address_purpose": "LOCATION",
            "city": "Bovey",
            "state": "MN",
            "postal_code": "557095524",
            "country_code": "US",
            "telephone_number": "218-683-4351",
            "fax_number": "218-683-4362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-03",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "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",
            "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 Behavioral Health Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thief River Falls, MN

Sources for this page

Verify at the official NPI Registry.