NPIMap

Organization Active NPI

North Sunflower Medical Center

Doing business as Sunflower Rural Health Clinic

  • Rural Health Clinic/Center
  • Ruleville, MS
National Provider Identifier
1154488393
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
11-168 Issued in MS
Legal business name
NORTH SUNFLOWER MEDICAL CENTER
Doing business as
Sunflower Rural Health Clinic
Practice address
840 N Oak Ave
Ruleville, MS 38771-3227
Phone
(662) 756-4024
Fax
(662) 756-4023
NPI assigned
Jan 3, 2007
Last updated
Jun 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jose D. Ceja Jr.
Title
Ceo
Phone
(662) 756-2711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 11-168 MS Primary

Addresses

Primary practice location

840 N Oak Ave
Ruleville, MS 38771-3227

Mailing address

840 N Oak Ave
Ruleville, MS 38771-3227
Phone (662) 756-4024

Other identifiers 2

IdentifierTypeStateIssuer
09013627MedicaidMS
9013863MedicaidMS

Other names 1

  • Sunflower Rural Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041123000318 MS Part B Supplier - Clinic/Group Practice 7618932294 Receives reassigned benefits from 109 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenwood, MS; Ruleville, MS
O20100422001127 MS Part A Provider - Rural Health Clinic 7618932294 Receives reassigned benefits from 1 practitioner
Practice locations: Ruleville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154488393. Details of each certification follow.

Rural health clinic certification: CCN 253400

Legal name
NORTH SUNFLOWER MEDICAL CENTER
Doing business as
SUNFLOWER RURAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 5, 1994
Last certification
Sep 30, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
840 N Oak Ave
Ruleville, MS 38771-3227
Related CCNs
251318

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0880658Sunflower Rural Health Clinic840 North Oak Ave, Ruleville, MS 38771ComplianceJan 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
North Sunflower Co Hosp19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Samuel Miller Individual Corporate OfficerExecutive Vice President Jul 26, 2015
Corporate DirectorExecutive Vice President Jul 26, 2015
Operational/Managerial ControlExecutive Vice President Jul 26, 2015
Jose Ceja Individual Corporate OfficerCfo Feb 5, 2020
Corporate DirectorCfo Feb 5, 2020
Operational/Managerial ControlCfo Feb 5, 2020
North Sunflower Medical Center Organization, Ruleville, MS Operational/Managerial Control Oct 1, 2014

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
North Sunflower Medical CenterRuleville, MS, CCN 251318 Hospital Operational/Managerial Control (100%) Oct 1, 2004
Sunflower Greenwood ClinicGreenwood, MS, CCN 258686 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 31, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591574400000",
    "number": "1154488393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 N OAK AVE",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387713227",
            "telephone_number": "662-756-4024",
            "fax_number": "662-756-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N OAK AVE",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387713227",
            "telephone_number": "662-756-4024",
            "fax_number": "662-756-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUNFLOWER MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A",
        "authorized_official_last_name": "CEJA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-756-2711",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "11-168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013627",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9013863",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunflower Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sunflower Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruleville, MS

Sources for this page

Verify at the official NPI Registry.