SANFORD MEDICAL CENTER FARGO (NPI# 1750661054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750661054 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD BROADWAY CLINIC |
| Practice Address |
801 Broadway N Fargo ND 58102-3641 |
| Practice Telephone | 7012342000 |
| Mailing Telephone | 7012342000 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-11-26 |
| Authorized Official Name | MARTHA LECLERC (VICE PRESIDENT) |
| Authorized Official Telephone | 7012346248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians | ||
| N | 204F00000X | Transplant Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians | ||
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| N | 291U00000X | Clinical Medical Laboratory | Laboratories | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Sanford Broadway Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245519081 | Sanford Medical Center Fargo | General Acute Care Hospital | 2990 Seter Parkway, Fargo, ND 58104-8750 | 2011-08-10 |
| 1558458844 | Sanford Medical Center Fargo | Pharmacy | 1720 S University Drive, Fargo, ND 58103-4940 | 2006-10-06 |
| 1578508198 | Sanford Medical Center Fargo | Clinic/Center | 1234 Washington Ave Ste B, Detroit Lakes, MN 56501-3906 | 2006-06-18 |
| 1225635634 | Sanford Medical Center Fargo | Pharmacy | 1720 University Dr S, Fargo, ND 58103-4940 | 2020-10-08 |
| 1174120281 | Sanford Medical Center Fargo | Pharmacy | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-10-02 |
| 1013559905 | Sanford Medical Center Fargo | Hospice Care, Community Based | 801 Broadway N, Fargo, ND 58102-3641 | 2019-10-11 |
| 1366092801 | Sanford Medical Center Fargo | Hospice Care, Community Based | 820 4th St N, Fargo, ND 58102-4539 | 2019-09-17 |
| 1861927709 | Sanford Medical Center Fargo | Pharmacy | 5225 23rd Ave S, Fargo, ND 58104 | 2017-04-28 |
| 1801151394 | Sanford Medical Center Fargo | Clinic/Center | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2012-07-10 |
| 1366717118 | Sanford Medical Center Fargo | Clinic/Center | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2012-03-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SANFORD MEDICAL CENTER FARGO | 720 N 4th St, Fargo, ND 58122-4520 |
| Street Address |
801 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-3641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528062924 | Mark F Fisher | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2005-06-13 |
| 1942809652 | Morgan Margaret Borud | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-10-22 |
| 1790392462 | Katie Thielges | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-09-28 |
| 1063022432 | Lindsey Schmidt | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-07-31 |
| 1336766161 | Yesha Shukla | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-27 |
| 1891310850 | Samantha Mimi Chang | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-15 |
| 1528683224 | Briana Lee Gebert-oberle | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-09 |
| 1689296931 | Jillian Virginia Schommer | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-05-09 |
| 1194344036 | Sarah Rose Carpenter | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-04-10 |
| 1346871258 | Randall Hagemeister | Nurse Anesthetist, Certified Registered | 801 Broadway N, Fargo, ND 58102-3641 | 2020-01-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184142747 | Kayla Estepp | Internal Medicine | 737 Broadway North, Fargo, ND 58122 | 2017-09-05 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1700238714 | Youstina Michael | Internal Medicine | 408 Roberts St N Apt 208, Fargo, ND 58102-4599 | 2016-07-01 |
| 1164834289 | Joshua Jost | Internal Medicine | Broadway N, 801, Fargo, ND 58122-0170 | 2014-05-22 |
| 1659782258 | Sarah Fanai | Internal Medicine | Sanford Health, 801 Broadway North, Fargo, ND 58122-0170 | 2014-05-16 |
| 1447696406 | Mohamad Imam | Internal Medicine | 801 Broadway North, Fargo, ND 58122 | 2013-05-17 |
| 1316383383 | Janya Swami | Internal Medicine | Sanford Health System 801 Broadway N, Fargo, ND 58122-0170 | 2013-05-17 |
| 1922361716 | Sanford Clinic North | Internal Medicine | 2960 Seter Pkwy, Fargo, ND 58104-8692 | 2012-06-18 |
| 1912273418 | Eric Priyakumar Ragland | Internal Medicine | Essentia Health, 3000 32nd Ave S, Fargo, ND 58104 | 2012-03-29 |
| 1811153802 | Suzanne L Vargot | Internal Medicine | 2102 Elm Str North, Dept of Veterans Affairs Medical Center, Fargo, ND 58102-2498 | 2008-07-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.