NPIMap

Organization Active NPI

South Sunflower County Hospital

  • General Acute Care Hospital
  • Indianola, MS
National Provider Identifier
1184679292
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
SOUTH SUNFLOWER COUNTY HOSPITAL
Practice address
121 E Baker St
Indianola, MS 38751-2450
Phone
(662) 887-5235
Fax
(662) 887-4111
NPI assigned
May 24, 2006
Last updated
Sep 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Authorized official

Name
Mr. Courtney R Phillips
Title
Administrator
Phone
(662) 887-5235

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

121 E Baker St
Indianola, MS 38751-2450

Mailing address

121 East Baker Street
Indianola, MS 38751-2450
Phone (662) 887-5235

Other identifiers 2

IdentifierTypeStateIssuer
00020032MedicaidMS
000020032OtherMSBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040218000979 MS Part B Supplier - Clinic/Group Practice 6709771637 Receives reassigned benefits from 88 practitioners
8 other NPIs on this enrollment
Practice locations: Indianola, MS
O20081204000525 MS Part A Provider - Hospital 6709771637 Practice locations: Southaven, MS; Oxford, MS; Indianola, MS; Hattiesburg, MS; Batesville, MS
O20141014000183 MS Part A Provider - Hospital 6709771637 Practice locations: Indianola, MS

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1184679292. Details of each certification follow.

Hospital certification: CCN 250095

Legal name
SOUTH SUNFLOWER COUNTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Feb 20, 1969
Last certification
Aug 19, 2022
Beds
69
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
121 E Baker Street
Indianola, MS 38751-2450
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved, Rehabilitation unit

Hospital certification: CCN 25U095

Legal name
SOUTH SUNFLOWER COUNTY HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
121 E Baker Street
Indianola, MS 38751-2450
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
South Sunflower County HospitalCCN 250095 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
S Sunflower Co Hosp14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: caitlinkisner@ssch.medalliesdirect.net
  • Direct secure messaging: edgardonahoe@ssch.medalliesdirect.net
  • Direct secure messaging: hannahray@ssch.medalliesdirect.net
  • Direct secure messaging: williamdowell@ssch.medalliesdirect.net

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
Courtney R Phillips Individual Corporate OfficerAdministrator Jul 1, 2014
W-2 Managing Employee Jul 1, 2014
South Sunflower County Hospital Organization, Indianola, MS 5% Or Greater Direct Ownership Interest Feb 20, 1969
Candace Sandling Individual W-2 Managing Employee Nov 1, 2023

Owners & managing parties with NPI records 2

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
Indianola Family Medical GroupIndianola, MS, CCN 258525 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 2002
Jan 1, 2002
Delta Primary Care ClinicIndianola, MS, CCN 258586 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)
Operational/Managerial Control (100%)		 Aug 15, 2013
Aug 15, 2013
Aug 15, 2013

Owned or controlled facilities with NPI records 2

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

  • South Sunflower County Hospital

    dba Indianola Family Medical Group

    • Rural Health Clinic/Center
    • Indianola, MS
    • NPI 1245248699

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • South Sunflower County Hospital

    dba Delta Primary Care Rural Health Clinic

    • Rural Health Clinic/Center
    • Indianola, MS
    • NPI 1821420936

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 91

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.

View all 91

Affiliated clinicians 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1184679292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 EAST BAKER STREET",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512450",
            "telephone_number": "662-887-5235",
            "fax_number": "662-887-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E BAKER ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512450",
            "telephone_number": "662-887-5235",
            "fax_number": "662-887-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SUNFLOWER COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-887-5235",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020032",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000020032",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianola, MS

Sources for this page

Verify at the official NPI Registry.