NPIMap

Organization Active NPI

Minidoka Memorial Hospital

  • Rural Health Clinic/Center
  • Rupert, ID
National Provider Identifier
1043387426
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
MMCRHC Issued in ID
Legal business name
MINIDOKA MEMORIAL HOSPITAL
Practice address
1308 8TH St
Suite 1
Rupert, ID 83350-1530
Phone
(208) 436-4322
Fax
(208) 434-8675
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MMCRHC ID Primary

Addresses

Primary practice location

1308 8TH St
Suite 1
Rupert, ID 83350-1530

Mailing address

1308 8TH St
Suite 1
Rupert, ID 83350-1530
Phone (208) 436-4322

Other identifiers 3

IdentifierTypeStateIssuer
74146OtherIDBLUE CROSS
M8073867MedicaidID
00001002451OtherIDBLUE SHIELD

Other names 1

  • Minidoka Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20041019001205 ID Part B Supplier - Clinic/Group Practice 7315908894 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rupert, ID
O20050428000396 ID Part A Provider - Rural Health Clinic 7315908894 Practice locations: Rupert, ID
O20050801000086 ID Part B Supplier - Clinic/Group Practice 7315908894 Receives reassigned benefits from 62 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rupert, ID; Burley, ID

Rural health clinic certification: CCN 138507

Legal name
MINIDOKA MEMORIAL HOSPITAL
Doing business as
MINIDOKA MEMORIAL HOSPITAL RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 27, 2005
Last certification
Jul 10, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1308 8TH St
Ste 1
Rupert, ID 83350-1535
Related CCNs
131319

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

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
13D0922942Minidoka Medical Center RHC1308 8TH St Ste 1, Rupert, ID 83350Certificate of waiverDec 10, 2027

National Provider Directory

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

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 10

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 Contracted Managing EmployeeChief Financial Officer Dec 1, 2025
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
Brenda M Broner Individual W-2 Managing EmployeeRN/Medical Staff Coordinator Jun 23, 2015
Nathan Kapple Individual Corporate DirectorTreasurer Board of Trustees Oct 1, 2025
Becky Bean Individual Corporate DirectorSecretary Board of Trustees Oct 1, 2025
Felicia Poteet Individual Corporate DirectorCred Secr Board of Trustees Oct 1, 2025
David Molina Individual Corporate DirectorBoard of Trustees Treasurer Jan 1, 2014
County of Minidoka Organization, Rupert, ID 5% Or Greater Direct Ownership Interest Jul 1, 1978 100%
Justin Percell Individual Corporate DirectorMember Board of Trustees Oct 1, 2025

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1043387426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 8TH ST",
            "address_2": "SUITE 1",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501530",
            "telephone_number": "208-436-4322",
            "fax_number": "208-436-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 8TH ST",
            "address_2": "SUITE 1",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501530",
            "telephone_number": "208-436-4322",
            "fax_number": "208-434-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIDOKA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ID",
            "license": "MMCRHC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "74146",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8073867",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00001002451",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minidoka Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rupert, ID

Sources for this page

Verify at the official NPI Registry.