NPIMap

Organization Active NPI

Minidoka Memorial Hospital

Doing business as Countyside Care and Rehab

  • Skilled Nursing Facility
  • Rupert, ID
National Provider Identifier
1023052040
Registry record updated Jan 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H26 Issued in ID
Legal business name
MINIDOKA MEMORIAL HOSPITAL
Doing business as
Countyside Care and Rehab
Practice address
1224 8TH St
Rupert, ID 83350-1527
Phone
(208) 436-0481
Fax
(208) 436-6038
NPI assigned
Jun 16, 2006
Last updated
Jan 18, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MINIDOKA MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas J Murphy
Title
Administrator
Phone
(208) 436-8141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H26 ID Primary

Addresses

Primary practice location

1224 8TH St
Rupert, ID 83350-1527

Mailing address

1224 8TH St
Rupert, ID 83350-1527
Phone (208) 436-0481

Other identifiers 1

IdentifierTypeStateIssuer
M0023369MedicaidID

Other names 1

  • Countyside Care and Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050708000794 ID Part A Provider - Skilled Nursing Facility 7315908894 Practice locations: Rupert, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023052040. Details of each certification follow.

Skilled nursing facility certification: CCN 135064

Legal name
MINIDOKA MEMORIAL HOSPITAL
Doing business as
COUNTRYSIDE CARE AND REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1976
Last certification
Sep 19, 2024
Beds
36
Ownership / control type
County
Organization structure
OtherNon-profit
Enrollment address
1224 8TH St
Rupert, ID 83350-1527
Nursing home name
COUNTRYSIDE CARE & REHABILITATION

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Countryside Care & RehabilitationCCN 135064 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Government - County
Certified
Dec 1, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3628.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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
13D2190075Countryside Care & Rehab1224 8TH St, Rupert, ID 83350Certificate of waiverAug 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Minidoka Memorial Hospi5 organizations share this tax ID, including this one
Part of
Minidoka Memorial Hospi

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tom J Legel Individual Corporate OfficerChief Financial Officer Dec 1, 2025
Rhett Miller Individual Corporate DirectorChairman Board of Trustees Oct 1, 2025
Joshua Bailey Individual Corporate DirectorVice Chairman Board of Trustees Oct 1, 2025
Nathan Kapple Individual Corporate DirectorTreasurer Board of Trustees Oct 1, 2025
Becky Bean Individual Corporate DirectorSecretary Board of Trustees Nov 3, 2025
Felicia Poteet Individual Corporate DirectorSecretary Board of Trustees Oct 1, 2025
David Molina Individual Corporate DirectorMember Board of Trustees Oct 1, 2025
County of Minidoka Organization, Rupert, ID 5% Or Greater Direct Ownership Interest Jul 1, 1978 100%
Adp of the SNF Jul 1, 1969
Tyson Dean Steel Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Lacey Blanchard Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
Justin Percell Individual Corporate DirectorMember Board of Trustees Oct 1, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453075200000",
    "number": "1023052040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 8TH ST",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-0481",
            "fax_number": "208-436-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 8TH ST",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-0481",
            "fax_number": "208-436-6038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIDOKA MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINIDOKA MEMORIAL HOSPITAL",
        "enumeration_date": "2006-06-16",
        "last_updated": "2016-01-18",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-436-8141"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "H26",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M0023369",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countyside Care and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rupert, ID

Sources for this page

Verify at the official NPI Registry.