NPIMap

Organization Active NPI

Minidoka Memorial Hospital

  • Critical Access Hospital
  • Rupert, ID
National Provider Identifier
1679553531
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
26 Issued in 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
Last updated
Mar 26, 2025By the provider in NPPES
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
Thomas J Murphy
Title
Administrator
Phone
(208) 436-8141

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 26 ID
Critical Access Hospital 282NC0060X 26 ID Primary

Addresses

Primary practice location

1224 8TH St
Rupert, ID 83350-1527

Mailing address

1224 8TH St
Rupert, ID 83350-1527
Phone (208) 436-0481

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID4 enrollments

Enrollment records 4

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
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

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1679553531. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
1224 8TH St
Rupert, ID 83350-1527
Main/Primary Hospital Location

Hospital certification: CCN 13Z319

Legal name
MINIDOKA MEMORIAL HOSPITAL
Doing business as
MINIDOKA MEMORIAL HOSPITAL
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1960 in ID
Enrollment address
1224 8TH St
Rupert, ID 83350-1527
Other Hospital Practice Location

Hospital certification: CCN 130019

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MINIDOKA MEMORIAL HOSPITAL
Certification status
Terminated Other: provider status change, Oct 1, 2001
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 13, 1997
Beds
27
Ownership / control type
Local
Facility address
1224 Eighth St
Rupert, ID 83350

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Minidoka Memorial HospitalCCN 131319 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

262 E 5TH St N
Burley, ID 83318
Phone (208) 436-0481

1218 9th St
Ste 11
Rupert, ID 83350
Phone (208) 436-4497

1218 9th St
Ste 12
Rupert, ID 83350
Phone (208) 436-4322

1308 8th St
Ste 4
Rupert, ID 83350
Phone (208) 436-4497

Ownership & related parties

All disclosed owners & managing parties 9

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 Employee Dec 1, 2025
Corporate OfficerChief Financial Officer Dec 1, 2025
Operational/Managerial Control Dec 1, 2025
Contracted Managing EmployeeChief Financial Officer Dec 1, 2025
Rhett Miller Individual Corporate DirectorChariman of Board Nov 20, 2025
Corporate DirectorChairman of the Board Nov 20, 2025 100%
Joshua Bailey Individual Corporate DirectorVice Chairman of the Board Nov 20, 2025
Corporate OfficerVice Chairman Board Nov 20, 2025
Nathan Kapple Individual Corporate DirectorTreasurer of the Board Nov 20, 2025
Corporate OfficerTreasurer of the Board Nov 20, 2025
Becky Bean Individual Corporate DirectorSecretary of the Board Nov 20, 2025
Corporate OfficerSecretary of the Board Nov 20, 2025
Felicia Poteet Individual Corporate DirectorCredentialing Secretary of Board Nov 20, 2025
Corporate OfficerCredentialing Secretary Board MBR Nov 20, 2025
David Molina Individual Corporate DirectorBoard Member Nov 20, 2025
Corporate OfficerBoard Member Nov 1, 2014
County of Minidoka Organization, Rupert, ID Medical provider/supplier 5% Or Greater Direct Ownership Interest Jul 1, 1969 100%
5% Or Greater Direct Ownership Interest Jan 1, 1969 100%
Justin Percell Individual Corporate DirectorBoard Member Nov 20, 2025
Corporate OfficerBoard Member Nov 20, 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 81

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.

View all 81

Affiliated clinicians 97

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

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1679553531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 8TH ST",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-0481",
            "fax_number": "208-436-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 8TH ST",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-0481",
            "fax_number": "208-434-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIDOKA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "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"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ID",
            "license": "26",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ID",
            "license": "26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rupert, ID

Sources for this page

Verify at the official NPI Registry.