The Evangelical Lutheran Good Samaritan Society

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Practice address

325 S Segrave St
Daytona Beach, FL 32114-4220

Phone

(386) 253-6791

Fax

(386) 258-3842

NPI assigned

Nov 15, 2005

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

Mr. Eric Vanden Hull

Title

VP, Finance

Phone

(605) 362-3100

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• Good Samaritan Society - Daytona Doing business as

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Red Oak Iowa Good Sam C

Member of 1

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

• The Evangelical Lutheran Good Samaritan Society

  • Skilled Nursing Facility
  • Sioux Falls, SD
  • NPI 1952385015

  Member Of

  NPD member

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

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

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1962484022",
    "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": "325 S SEGRAVE ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144220",
            "telephone_number": "386-253-6791",
            "fax_number": "386-258-3842"
        }
    ],
    "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": "2005-11-15",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "VANDEN HULL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VP, FINANCE",
        "authorized_official_telephone_number": "605-362-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ALF OSS",
            "identifier": "141221300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "7100409",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "675714601",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020439100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "K2S",
            "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 - Daytona",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Samaritan Society - Daytona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Daytona Beach, FL
• 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 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.