Active NPI
St Joseph Hospital LLC
- Oxygen Equipment & Supplies (DME)
- Lewiston, ID
National Provider Identifier
1992231799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oxygen Equipment & Supplies (DME)
- Legal business name
- ST JOSEPH HOSPITAL LLC
- Practice address
- 1250 Idaho St
Lewiston, ID 83501-1965 - Phone
- (208) 743-7427
- Fax
- (208) 743-7421
- NPI assigned
- May 11, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Johnetta Traylor
- Title
- Ao
- Phone
- (502) 596-6063
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oxygen Equipment & Supplies (DME) | 332BX2000X | Primary |
Addresses
Primary practice location
1250 Idaho St
Lewiston, ID 83501-1965
Mailing address
680 S 4TH St
Louisville, KY 40202-2407
Phone (502) 596-6063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170510002487 | ID | Part A Provider - Hospital | 8325325806 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lewiston, ID |
Hospital certification: CCN 130003
- Legal name
- ST JOSEPH HOSPITAL LLC
- Doing business as
- ST JOSEPH REGIONAL MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Feb 11, 2012
- Beds
- 145
- Ownership / control type
- Private (not for profit)
- Most recent change of ownership
- May 1, 2017 (4 total)
- Organization structure
- LLC
- Incorporated
- in DE
- Enrollment address
- 415 6TH St
Lewiston, ID 83501-2431 - Hospital subgroups
- General
Related certifications (CCN) 2
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Hospital
Medicare Care Compare- Listed as
- St Joseph Regional Medical Center
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider DirectoryLocations
1250 Idaho St
Lewiston, ID 83501
Phone (208) 743-7427
Ownership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Kindred Healthcare Operating LLC | Operational/Managerial Control | Dec 23, 2021 | 100% |
| Jacquelyn Joy Davis | Operational/Managerial Control | Dec 16, 2023 | |
| Scott Graeser | Corporate Officer | Aug 19, 2022 | |
| St Joseph Holdings LLC | 5% Or Greater Direct Ownership Interest | May 1, 2017 | 100% |
| Dana M Rock | Corporate Officer | Dec 9, 2024 | |
| Johnetta M Traylor | Corporate Officer | Dec 9, 2024 | |
| W-2 Managing Employee | Mar 17, 2025 | ||
| Russell Pigg | Corporate Officer | Mar 17, 2025 | |
| Knight Health Holdings LLC | 5% Or Greater Indirect Ownership Interest | Dec 23, 2021 | 100% |
| Michael Joseph Bean | Corporate Officer | Jan 21, 2022 | |
| Knight Healthcare New-B, LLC | 5% Or Greater Indirect Ownership Interest | Dec 23, 2021 | 100% |
| Knight Health II, LLC | 5% Or Greater Indirect Ownership Interest | Dec 23, 2021 | 100% |
| Alan Wenk | Corporate Officer | Mar 17, 2025 |
Affiliated clinicians 291
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Physical Medicine & Rehabilitation Physician
- Boise, ID
- NPI 1134749799
Inpatient rehabilitation facility
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750809600000",
"number": "1992231799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 S 4TH ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402022407",
"telephone_number": "502-596-6063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 IDAHO ST",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835011965",
"telephone_number": "208-743-7427",
"fax_number": "208-743-7421"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST JOSEPH HOSPITAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-05-11",
"last_updated": "2025-06-25",
"certification_date": "2025-06-25",
"status": "A",
"authorized_official_last_name": "TRAYLOR",
"authorized_official_first_name": "JOHNETTA",
"authorized_official_title_or_position": "AO",
"authorized_official_telephone_number": "502-596-6063"
},
"taxonomies": [
{
"code": "332BX2000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.