NPIMap

Organization Active NPI

St Lukes Wood River Medical Center LTD

Doing business as St Lukes Wood River Medical Center

  • Critical Access Hospital
  • Ketchum, ID
National Provider Identifier
1508869470
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
62 Issued in ID
Legal business name
ST LUKES WOOD RIVER MEDICAL CENTER LTD
Doing business as
St Lukes Wood River Medical Center
Practice address
100 Hospital Dr
Ketchum, ID 83340-9998
Phone
(208) 727-8100
NPI assigned
May 24, 2005
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
Critical Access Hospital 282NC0060X 62 ID Primary

Addresses

Primary practice location

100 Hospital Dr
Ketchum, ID 83340-9998

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
805909800MedicaidID

Other names 1

  • St Lukes Wood River Medical Center 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
O20061104000078 ID Part A Provider - Critical Access Hospital 0244147148 Practice locations: Hailey, ID; Ketchum, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508869470. Details of each certification follow.

Hospital certification: CCN 131323

Legal name
ST LUKES WOOD RIVER MEDICAL CENTER LTD
Doing business as
ST LUKES WOOD RIVER MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 16, 2003
Last certification
Apr 18, 2013
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1996 in ID
Enrollment address
100 Hospital Dr Ste 201
Ketchum, ID 83340-9998
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Luke's Wood River Medical CenterCCN 131323 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Medical Ctr Wo4 organizations share this tax ID, including this one
Part of
St Luke's Children's

Other organizations with this tax ID 3

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

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Durmot Mark Durcan Individual Corporate DirectorBoard Member Oct 1, 2018
Lisa Grow Individual Corporate DirectorBoard Member Oct 1, 2018
Emily Baker Individual Corporate DirectorBoard Member Oct 1, 2021
Allan Korn Individual Corporate DirectorBoard Member Oct 1, 2018
Robert Lokken Individual Corporate DirectorBoard Member Oct 1, 2018
Andrew Scoggin Individual Corporate DirectorBoard Member Oct 1, 2018
Richard Raimondi Individual Corporate DirectorBoard Member Oct 1, 2018
Lucie a Dimaggio Individual Corporate DirectorBoard Member Oct 1, 2018
Daniel Krahn Individual Corporate DirectorBoard Member Oct 1, 2018
St Lukes Health System LTD Organization, Boise, ID Corporation 5% Or Greater Direct Ownership Interest Mar 1, 2007 100%
Jon Miller Individual Corporate DirectorBoard Member Oct 1, 2018
Jared Grant Individual Corporate OfficerSystem Controller & Treasurer Jan 19, 2023
W-2 Managing EmployeeSystem Controller & Treasurer Jan 19, 2023
Karen Vauk Individual Corporate DirectorBoard Member Oct 1, 2018
Jacob Reid Individual Corporate OfficerPFM Administrator Sep 1, 2023
W-2 Managing EmployeePFM Administrator Sep 1, 2023
Kathryn Fowler Individual Corporate OfficerVP Operational Finance Feb 1, 2021
Corporate DirectorVP Operational Finance Feb 1, 2021
W-2 Managing EmployeeVP Operational Finance Feb 1, 2021
Rosa Davila Individual Corporate DirectorBoard Member Oct 1, 2021
William Whitacre Individual Corporate DirectorBoard Member Oct 1, 2018
Christopher Roth Individual Corporate Officer Feb 1, 2020
Corporate DirectorPresident & Ceo Feb 1, 2020
W-2 Managing EmployeePresident & Ceo Feb 1, 2020
Robert Mueller Individual Corporate OfficerVP Revenue Cycle Oct 1, 2015
Corporate DirectorVP Revenue Cycle Oct 1, 2015
W-2 Managing EmployeeVP Revenue Cycle Oct 1, 2015
Thomas K Corrick Individual Corporate DirectorBoard Member Oct 1, 2018
Brigette Bilyeu Individual Corporate DirectorBoard Member Oct 1, 2018

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 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 5

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 293

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

View all 293

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1508869470",
    "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": "100 HOSPITAL DR",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833409998",
            "telephone_number": "208-727-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES WOOD RIVER MEDICAL CENTER LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKES HEALTH SYSTEM LTD",
        "enumeration_date": "2005-05-24",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ID",
            "license": "62",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805909800",
            "state": "ID"
        }
    ],
    "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 Wood River Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ketchum, ID

Sources for this page

Verify at the official NPI Registry.