NPIMap

Organization Active NPI

St Lukes Regional Medical Center

Doing business as St Lukes Elmore Long Term Care

  • Skilled Nursing Facility
  • Mountain Home, ID
National Provider Identifier
1508105248
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H5 Issued in ID
Legal business name
ST LUKES REGIONAL MEDICAL CENTER
Doing business as
St Lukes Elmore Long Term Care
Practice address
895 N 6TH E
Mountain Home, ID 83647-2207
Phone
(208) 580-2670
NPI assigned
Jan 31, 2013
Last updated
Apr 23, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ST LUKES HEALTH SYSTEM LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Kathryn Fowler
Title
Senior VP, Cfo
Phone
(208) 381-8717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H5 ID Primary

Addresses

Primary practice location

895 N 6TH E
Mountain Home, ID 83647-2207

Mailing address

PO Box 2777
Boise, ID 83701-2777
Phone (208) 706-5000

Other names 1

  • ST LUKES ELMORE LONG TERM CARE Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130410000479 ID Part A Provider - Skilled Nursing Facility 5799692604 Practice locations: Mountain Home, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508105248. Details of each certification follow.

Skilled nursing facility certification: CCN 135006

Legal name
ST LUKES REGIONAL MEDICAL CENTER
Doing business as
ST LUKES ELMORE LONG TERM CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Jan 24, 2025
Beds
38
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 20, 1906 in ID
Enrollment address
895 N 6TH E
Mountain Home, ID 83647-2207
Nursing home name
ST LUKE'S ELMORE LONG TERM CARE

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Care Compare: Nursing home

Medicare Care Compare
Listed as
St Luke's Elmore Long Term CareCCN 135006 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3816.3 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
13D2189985St Luke's Elmore Long Term Care895 N 6TH E St, Mountain Home, ID 83647Certificate of waiverAug 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Regional Med Ctr50 organizations share this tax ID, including this one
Part of
St Luke's Children's

Other organizations with this tax ID 49

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

View all 49

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Laura a McGeorge Individual Corporate DirectorBoard Member Jul 1, 2024
Lisa Grow Individual Corporate DirectorAt-Large, Board Member Oct 1, 2018
Emily Baker Individual Corporate DirectorAt Large, Board Member Oct 1, 2021
Lisa Melchiorre Individual Operational/Managerial Control Oct 1, 2019
Adp of the SNF Oct 1, 2019
Robert Lokken Individual Corporate DirectorAt-Large, Board Member Oct 1, 2018
Andrew Scoggin Individual Corporate DirectorAt-Large, Board Member Oct 1, 2018
Megan M Sandmann Individual Operational/Managerial Control Jul 19, 2019
Adp of the SNF Jul 19, 2019
Richard Raimondi Individual Corporate DirectorBoard Member Oct 1, 2018
Daniel Krahn Individual Corporate DirectorAt-Large, Board Member Oct 1, 2018
St Lukes Health System LTD Organization, Boise, ID Chain home office Operational/Managerial Control Apr 1, 2013
Adp of the SNF Apr 1, 2013
Jared Grant Individual Corporate OfficerSystem Controller & Treasurer Jan 19, 2023
Operational/Managerial Control Jan 19, 2023
Adp of the SNF Jan 19, 2023
Jacob Reid Individual Corporate Director Sep 1, 2023
Operational/Managerial Control Sep 1, 2023
Adp of the SNF Sep 1, 2023
Kathryn Fowler Individual Corporate OfficerVP and Coo Feb 1, 2021
Operational/Managerial Control Feb 1, 2021
Adp of the SNF Feb 1, 2021
Rosa Davila Individual Corporate DirectorAt Large, Board Member Oct 1, 2021
William Gilbert Individual Corporate DirectorBoard Member Nov 1, 2022
William Whitacre Individual Corporate DirectorAt-Large, Board Member Oct 1, 2018
Christopher Roth Individual Corporate OfficerPresident & Ceo Jan 31, 2020
Operational/Managerial Control Oct 1, 2015
Adp of the SNF Jan 31, 2020
Jill Twedt Individual Corporate DirectorBoard Member Nov 1, 2022
Thomas K Corrick Individual Corporate DirectorAt-Large, Board Member Oct 1, 2018
William Ystueta Jr Individual Corporate DirectorBoard Member Oct 1, 2023

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Lukes Rehabilitation Inpatient Acute Care UnitBoise, ID, CCN 13T006 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2014
St Lukes Clinic - Eastern Oregan Medical AssociatesBaker City, OR, CCN 383852 Rural health clinic 5% Or Greater Direct Ownership Interest Sep 1, 2016
St Lukes Clinic-Trinity Mountain MedicalMountain Home, ID, CCN 133999 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2016

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 19

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

View all 19

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.

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 2

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": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1508105248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2777",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837012777",
            "telephone_number": "208-706-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 N 6TH E",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836472207",
            "telephone_number": "208-580-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKES HEALTH SYSTEM LTD",
        "enumeration_date": "2013-01-31",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "SENIOR VP, CFO",
        "authorized_official_telephone_number": "208-381-8717"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "H5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ST LUKES ELMORE LONG TERM CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ST LUKES ELMORE LONG TERM CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, ID

Sources for this page

Verify at the official NPI Registry.