SANFORD HEALTH OF NORTHERN MINNESOTA
Complete NPI Record 1780628149
Internal Medicine in Bemidji, MN
Active since June 16, 2006
Complete NPI Dataset
This page contains the complete raw NPPES record for Sanford Health Of Northern Minnesota (NPI 1780628149), an internal medicine organization in Bemidji, MN. All 52 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1780628149 Field 1/52
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/52
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/52
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: SANFORD HEALTH OF NORTHERN MINNESOTA Field 4/52
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/52
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/52
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: PO BOX 5074 Field 7/52
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: SIOUX FALLS Field 8/52
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: SD Field 9/52
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 571175074 Field 10/52
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/52
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 6053286585 Field 12/52
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 6053288311 Field 13/52
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1233 34TH ST NW Field 14/52
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: BEMIDJI Field 15/52
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MN Field 16/52
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 566015112 Field 17/52
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/52
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2183335000 Field 19/52
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2183335360 Field 20/52
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: MORRISON Field 23/52
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: TONY Field 24/52
- The first name of the authorized official.
- Authorized Official Middle Name: LEE Field 25/52
- The middle name of the authorized official.
- Authorized Official Title or Position: VICE PRESIDENT, REVENUE CYCLE Field 26/52
- The title or position of the authorized official.
- Authorized Official Telephone Number: 6053288380 Field 27/52
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207V00000X Field 28/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 29/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 208600000X Field 30/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 31/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 207ZP0101X Field 32/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 33/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 207L00000X Field 34/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: N Field 35/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 5: 207Q00000X Field 36/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 5: N Field 37/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 6: 261QM0801X Field 38/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 6: N Field 39/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 7: 207X00000X Field 40/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 7: N Field 41/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 8: 207R00000X Field 42/52
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 8: Y Field 43/52
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 44/52
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 45/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP Field 46/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 47/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP Field 48/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP Field 49/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP Field 50/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP Field 51/52
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 24
Additional business and trade names this provider has on file with the NPPES registry.
Joe Lueken Cancer Center Doing Business As
Name 1/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bagley Clinic Doing Business As
Name 2/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bagley Eye Center & Optical Doing Business As
Name 3/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji 1611 Anne St Clinic Doing Business As
Name 4/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji 1611 Eye Center & Optical Doing Business As
Name 5/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji 1705 Ann St Clinic Doing Business As
Name 6/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji 1705 Anne St Clinic Doing Business As
Name 7/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Behavioral Health Doing Business As
Name 8/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Blackduck Clinic Doing Business As
Name 9/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Cass Lake Clinic Doing Business As
Name 10/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Downtown Eye Center & Optical Doing Business As
Name 11/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Main Clinic Doing Business As
Name 12/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Main Clinic Outreach for Cook Doing Business As
Name 13/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Main Clinic Outreach to Neilson Place Doing Business As
Name 14/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Orthopedic and Sports Medicine Center Doing Business As
Name 15/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Bemidji Sleep Center Doing Business As
Name 16/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Baudette Eye Center & Optical Doing Business As
Name 17/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Behavioral Health Administration Office Doing Business As
Name 18/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Behavioral Health Headwaters ACT Doing Business As
Name 19/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health International Falls Eye Center & Optical Doing Business As
Name 20/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Park Rapids Behavioral Health Center Doing Business As
Name 21/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Park Rapids Clinic Doing Business As
Name 22/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Thief River Falls Eye Center & Optical Doing Business As
Name 23/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Sanford Health Walker Clinic Doing Business As
Name 24/24Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 27
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
4450 Aspenway
Location 1/27Duluth, MN 55810-9733 · Phone (218) 333-5000 · Fax (218) 333-5880
1720 Highway 59 S
Location 2/27Thief River Falls, MN 56701-4331 · Phone (218) 683-3937 · Fax (218) 683-2699
116 3rd St NW
Location 3/27Bemidji, MN 56601-3102 · Phone (218) 333-2220
110 7th St W
Location 4/27Park Rapids, MN 56470-1872 · Phone (218) 699-3121 · Fax (218) 699-3995
1009 Hollinger St
Location 5/27Park Rapids, MN 56470-1300 · Phone (218) 252-6608
1000 Anne St NW
Location 6/27Bemidji, MN 56601-5109 · Phone (218) 751-0220
1705 Anne St NW
Location 7/27Bemidji, MN 56601-6151 · Phone (218) 333-5000 · Fax (218) 333-5880
1000 Coney St W
Location 8/27Perham, MN 56573-2102 · Phone (218) 347-1200 · Fax (218) 347-1290
506 Beltrami Ave NW
Location 9/27Bemidji, MN 56601-3010 · Phone (218) 751-2020
1656 Central St W
Location 10/27Bagley, MN 56621-4357 · Phone (218) 694-2384
81 1st St NW
Location 11/27Blackduck, MN 56630-2228 · Phone (218) 835-4222
801 Broadway N
Location 12/27Fargo, ND 58102-3641 · Phone (701) 234-2000
1611 Anne St NW
Location 13/27Bemidji, MN 56601-5114 · Phone (218) 333-5000
4179 8th St SW
Location 14/27Backus, MN 56435-2340 · Phone (218) 333-5000 · Fax (218) 333-5360
4003 Crosley Ave
Location 15/27Cincinnati, WI 54212 · Phone (218) 333-5000
992 Starlight Pl
Location 16/27Rockwall, TX 75087-2294 · Phone (218) 333-5000
219 Grant Utley Ave NW
Location 17/27Cass Lake, MN 56633-3619 · Phone (218) 335-2559
1300 Anne St NW
Location 18/27Bemidji, MN 56601-5103 · Phone (218) 333-5000 · Fax (218) 333-5360
3717 Pine Ridge Ave NW
Location 19/27Bemidji, MN 56601-5106 · Phone (218) 333-4527
1580 Highway 71
Location 20/27International Falls, MN 56649-2131 · Phone (218) 598-5665
100 Huntsinger Ave
Location 21/27Park Rapids, MN 56470-1326 · Phone (218) 732-3389 · Fax (218) 732-5994
1400 Highway 71
Location 22/27International Falls, MN 56649-2154 · Phone (218) 598-5665 · Fax (218) 598-5329
614 Michigan Ave W
Location 23/27Walker, MN 56484-2276 · Phone (218) 547-7700 · Fax (218) 547-7729
111 2nd St NE
Location 24/27Fosston, MN 56542-1301 · Phone (218) 435-1010 · Fax (218) 435-1715
1656 Central St W Ste A
Location 25/27Bagley, MN 56621-4357 · Phone (218) 694-2442 · Fax (218) 694-2446
3220 Hannah Ave NW Ste 2
Location 26/27Bemidji, MN 56601 · Phone (218) 209-3600
715 Delmore Dr
Location 27/27Roseau, MN 56751-1534 · Phone (218) 463-2500
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