Sanford Clinic
Organization Active NPI Physical Medicine & Rehabilitation Physician · Sioux Falls, SD
NPI 1912913328 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1912913328
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- SANFORD CLINIC
- Practice address
- 1210 W 18TH St
Suite 100
Sioux Falls, SD 57104-9890 - Phone
- (605) 312-8500
- Fax
- (605) 312-8501
- NPI assigned
- Jul 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Tony Lee Morrison
- Title
- Vice President, Revenue Cycle
- Phone
- (605) 328-8380
Other NPIs on the same Medicare enrollment 28
Practitioners 1
-
Cory Lynn Olson, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SD, MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Locations
708 E Kay Ave
Mitchell, SD 57301
Phone (605) 292-0792
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes |
Addresses
Primary practice location
1210 W 18TH St
Suite 100
Sioux Falls, SD 57104-9890
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0573535 | Medicaid | IA | |
| 281988100 | Medicaid | MN |
Other names
- Sanford Physical Medicine and Rehabilitation
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other |
Other providers in Sioux Falls, SD
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Clinic
- Sanford Consumer Services LLC
- Sanford Consumer Services LLC
All providers in Sioux Falls, SD · Physical Medicine & Rehabilitation Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.