The Evangelical Lutheran Good Samaritan Society

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Doing business as

Good Samaritan Society - Boise Village

Practice address

129 E 50TH St
Garden City, ID 83714-2407

Phone

(208) 333-2180

NPI assigned

Nov 10, 2005

Organization subpart

Yes

Parent organization

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETYAs reported in NPPES

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

Authorized official

Name

Ms. Raye Nae Nylander

Title

Cfo

Phone

(605) 362-3100

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Good Samaritan Society - Boise Village Doing business as

Electronic endpoints 1

Part of

Red Oak Iowa Good Sam C

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The Evangelical Lutheran Good Samaritan Society

  • Skilled Nursing Facility
  • Sioux Falls, SD
  • NPI 1952385015

  Member Of

  NPD member

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• The Evangelical Lutheran Good Samaritan Society

  • Assisted Living Facility
  • Boise, ID
  • NPI 1306069281
  NPPES parent name

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1053392548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5038",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175038",
            "telephone_number": "605-362-3100",
            "fax_number": "605-362-3265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 E 50TH ST",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837142407",
            "telephone_number": "208-333-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "enumeration_date": "2005-11-10",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "NYLANDER",
        "authorized_official_first_name": "RAYE NAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-362-3100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0000100129001",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC - IDAHO",
            "identifier": "01123",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000371800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ID - TBI PROGRAM",
            "identifier": "805490400",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Good Samaritan Society - Boise Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Samaritan Society - Boise Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.