GOOD SAMARITAN SOCIETY - SCANDIA VILLAGE
NPI 1528049301
Skilled Nursing Facility in Sister Bay, WI
NPI Status: Active since November 09, 2005
Contact Information
10560 APPLEWOOD DR
SISTER BAY, WI
ZIP 54234
Phone: (920) 854-2317
Fax: (920) 854-9529
- Organization
- Skilled Nursing Facility
- Accepts Insurance
- CLIA Number: 52D0394778
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 08-31-2026
About GOOD SAMARITAN SOCIETY - SCANDIA VILLAGE
This page provides the complete NPI Profile along with additional information for Good Samaritan Society - Scandia Village, a provider established in Sister Bay, Wisconsin operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1528049301 assigned on November 2005. The practitioner's primary taxonomy code is 314000000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's is doing business as Good Samaritan Society - Scandia Village. The authorized official of this NPI record is Mrs. Raye Nae Nylander (Cfo)
- NPI
- 1528049301
- Provider Legal Name
- THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- Other Organization Name
- GOOD SAMARITAN SOCIETY - SCANDIA VILLAGE
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 10560 APPLEWOOD DR SISTER BAY, WI 54234
- Location Phone
- (920) 854-2317
- Location Fax
- (920) 854-9529
- Mailing Address
- PO BOX 5038 SIOUX FALLS, SD 57117
- Mailing Phone
- (605) 362-3100
- Mailing Fax
- (920) 854-9529
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 11-09-2005
- Last Update Date
- 11-28-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Skilled Nursing Facility
- Taxonomy Code
- 314000000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 332BN1400X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| 2 | 332BP3500X | Suppliers | Durable Medical Equipment & Medical Supplies |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Robin Oak $1,000 Gold - PPO
- Robin Oak $1,500 Standard Gold - PPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
- UHC Bronze Standard (No Referrals) - HMO
- UHC Bronze Value HSA (No Referrals) - HMO
- UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Gold Standard (No Referrals) - HMO
- UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
- UHC Silver Standard (No Referrals) - HMO
- UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Silver Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 20172400 | MEDICAID (05) | WI |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D0394778
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- DR. RORY M. JOHNSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Good Samaritan Society - Scandia Village to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 5 | 2 | 8 | 0 | 4 | 9 | 3 | 0 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 4 | 8 | 0 | 4 | 18 | 3 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 4 + 8 + 0 + 4 + 1 + 8 + 3 + 0 + 24 = 59 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 59 = 1 | 1 | ||||||||
The NPI number 1528049301 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
RACHAEL ANNE CHOMEAU PTA
Physical Therapy Assistant
10560 APPLEWOOD DR
SISTER BAY, WI
ZIP 54234
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1528049301, enumerated as an "organization" on November 09, 2005.
The provider is located at 10560 APPLEWOOD DR SISTER BAY, WI 54234 and the phone number is (920) 854-2317.
Skilled Nursing Facility with taxonomy code 314000000X.
The provider might be accepting Accepts: HealthPartners, UnitedHealthcare, Medicare and. Please consult your insurance carrier or call the provider to verify.
