Minidoka Memorial Hospital
Organization Active NPI Critical Access Hospital · Rupert, ID
NPI 1679553531 · NPPES record last updated Mar 26, 2025
Key facts
- NPI
- 1679553531
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 26 (ID)
- Legal business name
- MINIDOKA MEMORIAL HOSPITAL
- Practice address
- 1224 8TH St
Rupert, ID 83350-1527 - Phone
- (208) 436-0481
- Fax
- (208) 434-8675
- NPI assigned
- Jan 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Thomas J Murphy
- Title
- Administrator
- Phone
- (208) 436-8141
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 81
-
Meg Estelle Bollinger, FNP-C
-
Ryan Callahan, D.O
-
Lanny F Campbell, MD
-
Robert Louis Coray, M.D.
-
Gilbert K Crane, M.D
-
Tanya Reid Crystal, FNP-C
-
Cody Cunningham, DO
-
Mark Dahle, MD
-
Justin Moroni Dazley, M.D.
-
Derek Harper, DPM
-
Jeremy B Haymore, M.D.
-
Joseph C Hymas, MD
-
Ryan Bradley Longmore, D.O.
-
Cameron McHan, FNP-C
-
Rohn Tyler McKee, D.O.
-
Brian R Muir, D.O.
Affiliated clinicians 97
-
Shelly Ann Abell, FNP
-
Gregory R Ball, DO
-
Steven Boehmer, DO
-
Greg C Boettcher, DO
-
Meg Estelle Bollinger, FNP-C
-
Robert Lee Cach, M.D.
-
Lanny F Campbell, MD
-
Ronald Bret Campbell, D.O.
-
Robert Louis Coray, M.D.
-
Gilbert K Crane, M.D
-
Tanya Reid Crystal, FNP-C
-
Cody Cunningham, DO
-
Mark Dahle, MD
-
Justin Moroni Dazley, M.D.
-
Timothy Adam Enders, D.O.
-
Daryl G Ficklin, DO
Medicare Care Compare: Hospital
- Listed as
- Minidoka Memorial Hospital
- Type
- Critical Access Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in ID
Hospital certification: CCN 131319
- Legal name
- MINIDOKA MEMORIAL HOSPITAL
- Doing business as
- MINIDOKA MEMORIAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Oct 1, 2001
- Last certification
- Aug 13, 2015
- Beds
- 25
- Ownership / control type
- Local
- Organization structure
- Government · Non-profit
- Enrollment address
- 1224 8TH St
Rupert, ID 83350-1527
Hospital certification: CCN 13Z319
- Legal name
- MINIDOKA MEMORIAL HOSPITAL
- Doing business as
- MINIDOKA MEMORIAL HOSPITAL
- Organization structure
- Government · Non-profit
- Incorporated
- Jul 1, 1960 in ID
- Enrollment address
- 1224 8TH St
Rupert, ID 83350-1527
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Tom J Legel |
Contracted Managing Employee | Dec 1, 2025 | |
| Corporate Officer |
Dec 1, 2025 | ||
| Operational/Managerial Control | Dec 1, 2025 | ||
| Contracted Managing Employee |
Dec 1, 2025 | ||
| Rhett Miller |
Corporate Director |
Nov 20, 2025 | |
| Corporate Director |
Nov 20, 2025 | 100% | |
| Joshua Bailey |
Corporate Director |
Nov 20, 2025 | |
| Corporate Officer |
Nov 20, 2025 | ||
| Nathan Kapple |
Corporate Director |
Nov 20, 2025 | |
| Corporate Officer |
Nov 20, 2025 | ||
| Becky Bean |
Corporate Director |
Nov 20, 2025 | |
| Corporate Officer |
Nov 20, 2025 | ||
| Felicia Poteet |
Corporate Director |
Nov 20, 2025 | |
| Corporate Officer |
Nov 20, 2025 | ||
| David Molina |
Corporate Director |
Nov 20, 2025 | |
| Corporate Officer |
Nov 1, 2014 | ||
| County of Minidoka |
5% Or Greater Direct Ownership Interest | Jul 1, 1969 | 100% |
| 5% Or Greater Direct Ownership Interest | Jan 1, 1969 | 100% | |
| Justin Percell |
Corporate Director |
Nov 20, 2025 | |
| Corporate Officer |
Nov 20, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20050801000086 | ID | Part B Supplier - Clinic/Group Practice | 7315908894 |
Receives reassigned benefits from 62 practitioners 2 other NPIs on this enrollment Practice locations: Rupert, ID; Burley, ID |
| O20061104000542 | ID | Part a Provider - Critical Access Hospital | 7315908894 |
Receives reassigned benefits from 61 practitioners Practice locations: Burley, ID; Rupert, ID |
| O20071002000478 | ID | Part a Provider - Critical Access Hospital | 7315908894 | Practice locations: Rupert, ID |
National Provider Directory
Locations
260 E 5th N
Burley, ID 83318
Phone (208) 678-9760
262 E 5TH St N
Burley, ID 83318
Phone (208) 436-0481
1218 9th St
Ste 12
Rupert, ID 83350
Phone (208) 436-4322
1308 8th St
Ste 4
Rupert, ID 83350
Phone (208) 436-4497
1218 9th St
Ste 11
Rupert, ID 83350
Phone (208) 436-4497
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 26 | ID | |
| Critical Access Hospital | 282NC0060X | 26 | ID | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010006548 | Other | ID | BLUE SHIELD |
| 00166 | Other | ID | BLUE CROSS |
| 1254303 | Other | CIGNA GOVERNMENT SERVICES | |
| M0023360 | Medicaid | ID |
Other providers in Rupert, ID
- Mini-Cassia Surgical PC
- Minidoka County School District #331
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital Ambulance
- Minidoka Memorial Hospital Crna Group
- Laura Moore
- Mt. Harrison Audiology and Hearing AIDS LLC
All providers in Rupert, ID · Critical Access Hospital in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.