The Evangelical Lutheran Good Samaritan Society

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Doing business as

Good Samaritan Society - Kissimmee Village

Practice address

1500 Southgate Dr
Kissimmee, FL 34746-6593

Phone

(407) 846-7201

Fax

(407) 846-6782

NPI assigned

Oct 24, 2005

Last updated

Oct 25, 2021By the provider in NPPES

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 2

Other names 1

• Good Samaritan Society - Kissimmee Village Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679563407. Details of each certification follow.

• CCN 105559 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 105559

Legal name

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Doing business as

GOOD SAMARITAN SOCIETY - KISSIMMEE VILLAGE (SNF)

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 20, 1987

Last certification

Feb 1, 2024

Beds

161

Ownership / control type

Nonprofit Corporation

Multi-facility organization

The Evangelical Good Samaritan Society

Organization structure

CorporationNon-profit

Incorporated

Sep 29, 1922 in ND

Enrollment address

1500 Southgate Dr
Kissimmee, FL 34746-6599

Nursing home name

THE GOOD SAMARITAN SOCIETY-KISSIMMEE VILLAGE

Affiliated entity

GOOD SAMARITAN SOCIETY

Listed as

The Good Samaritan Society-Kissimmee VillageCCN 105559 · All quality measures

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

5 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

May 20, 1987

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

161136.6 residents per day on average

Chain

Good Samaritan Society92 facilities in the chain

Penalties (3 years)

1Fines totaling $11,629

Processed by Care Compare on Aug 1, 2026.

Part of

Good Samaritan Home

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.

Owners & managing parties with NPI records 1

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

• Christopher M Chappel, MD

  • Family Medicine Physician
  • Kissimmee, FL
  • NPI 1174589469

  Contracted Managing Employee

  CMS ownership

All facility ownership & control disclosures 108

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

Showing 100 of 108 facilities.

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

  dba Florida Lutheran Retirement Center

  • Assisted Living Facility
  • Deland, FL
  • NPI 1659595841
  NPPES parent name

Affiliated clinicians 1

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

• Latchman Sharma Hardowar, M.D.

  • Family Medicine Physician
  • Kissimmee, FL
  • NPI 1043279151

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1679563407",
    "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": "1500 SOUTHGATE DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347466593",
            "telephone_number": "407-846-7201",
            "fax_number": "407-846-6782"
        }
    ],
    "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": "2005-10-24",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020530300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "N26",
            "state": "FL"
        }
    ],
    "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 - Kissimmee Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Samaritan Society - Kissimmee Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Devereux Foundation
• The Docline
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• The Elite Care Company I LLC
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Cares)
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Manor)
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Services@Home)
• The Family Physician of BVL
• The Florida Foot and Ankle Institute
• The Gentle Shepherd Assisted Living Facility

• Skilled Nursing Facility in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.