NPIMap

Organization Active NPI

South Sunflower County Hospital

Doing business as Indianola Family Medical Group

  • Rural Health Clinic/Center
  • Indianola, MS
National Provider Identifier
1245248699
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTH SUNFLOWER COUNTY HOSPITAL
Doing business as
Indianola Family Medical Group
Practice address
122 E Baker St
Indianola, MS 38751-2451
Phone
(662) 887-2212
Fax
(662) 887-1279
NPI assigned
Aug 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jim Woods
Title
Clinic Administrator
Phone
(662) 887-2212

Specialties & licenses 1

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

Addresses

Primary practice location

122 E Baker St
Indianola, MS 38751-2451

Mailing address

122 E Baker St
Indianola, MS 38751-2451
Phone (662) 887-2212

Other identifiers 2

IdentifierTypeStateIssuer
08904503MedicaidMS
09015873MedicaidMS

Other names 1

  • Indianola Family Medical Group Doing business as

Medicare participation

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

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Indianola, MS
O20050808001033 MS Part A Provider - Rural Health Clinic 6709771637 Practice locations: Indianola, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245248699. Details of each certification follow.

Rural health clinic certification: CCN 258525

Legal name
SOUTH SUNFLOWER COUNTY HOSPITAL
Doing business as
INDIANOLA FAMILY MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 22, 2005
Last certification
Oct 1, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
122 East Baker St
Indianola Family Medical Group
Indianola, MS 38751-2451
Related CCNs
250095

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.

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
25D0316807Indianola Family Medical Group122 East Baker Street, Indianola, MS 38751AccreditationDec 22, 2027

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

Interoperability endpoints

  • Direct secure messaging: bethmcneer@ifmg.allscriptsdirect.net
  • Direct secure messaging: bobbypaxton@ifmg.allscriptsdirect.net
  • Direct secure messaging: chaddowell@ifmg.allscriptsdirect.net
  • Direct secure messaging: charlottebrunetti@ifmg.allscriptsdirect.net
  • Direct secure messaging: cullencopeland@ifmg.allscriptsdirect.net
  • Direct secure messaging: edgardonahoe@ifmg.allscriptsdirect.net
  • Direct secure messaging: elizabethdawson@ifmg.allscriptsdirect.net
  • Direct secure messaging: eriklessmann@ifmg.allscriptsdirect.net
  • Direct secure messaging: hannahray@ifmg.allscriptsdirect.net
  • Direct secure messaging: kelseydowell@ifmg.allscriptsdirect.net
  • Direct secure messaging: kristensmith@ifmg.allscriptsdirect.net
  • Direct secure messaging: lindsayburke@ifmg.allscriptsdirect.net
  • Direct secure messaging: rogerblake@ifmg.allscriptsdirect.net
  • Direct secure messaging: terrierowland@ifmg.allscriptsdirect.net
  • Direct secure messaging: terrydorsey@ifmg.allscriptsdirect.net
  • Direct secure messaging: virginiapantin@ifmg.allscriptsdirect.net
  • Direct secure messaging: wadedowell@ifmg.allscriptsdirect.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 5% Or Greater Direct Ownership InterestCeo Jul 1, 2014 100%
South Sunflower County Hospital Organization, Indianola, MS 5% Or Greater Direct Ownership Interest Jan 1, 2002
Operational/Managerial Control Jan 1, 2002
Candace Sandling Individual W-2 Managing Employee Jan 1, 2015

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 3

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

FacilityTypeRoleSince
South Sunflower County HospitalIndianola, MS, CCN 250095 Hospital 5% Or Greater Direct Ownership Interest Feb 20, 1969
South Sunflower County HospitalIndianola, MS, CCN 25U095 Hospital 5% Or Greater Direct Ownership Interest Feb 20, 1969
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.

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245248699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E BAKER ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512451",
            "telephone_number": "662-887-2212",
            "fax_number": "662-887-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E BAKER ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512451",
            "telephone_number": "662-887-2212",
            "fax_number": "662-887-1279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SUNFLOWER COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "662-887-2212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08904503",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015873",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indianola Family Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianola, MS

Sources for this page

Verify at the official NPI Registry.