NPIMap

Organization Active NPI

Delta Health System

Doing business as Delta Health-The Medical Center

  • Rural Acute Care Hospital
  • Greenville, MS
National Provider Identifier
1306921887
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
11-189 Issued in MS
Legal business name
DELTA HEALTH SYSTEM
Doing business as
Delta Health-The Medical Center
Practice address
1400 East Union St
Greenville, MS 38703-3246
Phone
(662) 378-3783
Fax
(662) 725-2289
NPI assigned
Oct 25, 2006
Last updated
Nov 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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

Authorized official

Name
Ms. Iris Y. Stacker, RHIA
Title
Interim Ceo
Phone
(662) 725-2099

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU
Rural Acute Care Hospital 282NR1301X 11-189 MS Primary

Addresses

Primary practice location

1400 East Union St
Greenville, MS 38703-3246

Mailing address

1400 East Union St
Greenville, MS 38703-3246
Phone (662) 378-3783

Other practice location 1

300 S Washington Ave
Greenville, MS 38701-4719
Phone (662) 378-3783

Other identifiers 2

IdentifierTypeStateIssuer
000020145OtherMSBLUE CROSS PROVIDER NUMBE
000020145MedicaidMS

Other names 2

  • Delta Health-The Medical Center Doing business as
  • Delta Regional Medical Center Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040503000961 MS Part B Supplier - Clinic/Group Practice 0042208787 Receives reassigned benefits from 3 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksdale, MS; Cleveland, MS; Greenville, MS
O20071127000626 MS Part A Provider - Hospital 0042208787 3 other NPIs on this enrollment
Practice locations: Greenville, MS; Clarksdale, MS; Cleveland, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306921887. Details of each certification follow.

Hospital certification: CCN 250082

Legal name
DELTA HEALTH SYSTEM
Doing business as
DELTA HEALTH-THE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 19, 1967
Last certification
May 19, 2022
Beds
268
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
1400 E Union St
Greenville, MS 38703-3246
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Delta Health System - the Medical CenterCCN 250082 · All quality measures
Overall star rating
1 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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Matthew Jackson Mosow Individual Corporate Director Nov 21, 2022
Henry Rucker Individual Corporate Director Oct 1, 2001
George Bryan Oakes Individual Corporate DirectorVice-Chair Jul 1, 2020
V.L. Lee Sandifer Individual Corporate Officer Jun 1, 2019
Malcolm Jackson Individual Corporate Director May 16, 2022
Jamelda Fulton Individual Corporate DirectorChairman/Board of Trustees Dec 1, 2017
Monty Beasley Individual Corporate OfficerCfo Oct 23, 2025
W-2 Managing EmployeeAd; Oct 23, 2025
Iris Y Stacker Individual Corporate OfficerChief Executive Officer Jul 15, 2022
W-2 Managing Employee Aug 1, 1989

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Delta Health-the Medical Center (Ip Rehab)Greenville, MS, CCN 25T082 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1984
Delta Health-the Medical CenterGreenville, MS, CCN 257098 Home health agency 5% Or Greater Direct Ownership Interest Nov 24, 1975
Delta Health - the Medical Center (Hospice)Greenville, MS, CCN 251538 Hospice 5% Or Greater Direct Ownership Interest Nov 24, 1975
Delta Health SystemGreenville, MS, CCN 253461 Rural health clinic Operational/Managerial Control (100%) Jun 10, 1996

Owned or controlled facilities with NPI records 4

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

  • Delta Health System

    dba Delta Health-The Medical Center

    • Community Based Hospice Care Agency
    • Greenville, MS
    • NPI 1295822575

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

    • Rural Health Clinic/Center
    • Greenville, MS
    • NPI 1366592610

    Operational/Managerial Control

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

    • Home Health Agency
    • Greenville, MS
    • NPI 1477651362

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

    • Rehabilitation Hospital Unit
    • Greenville, MS
    • NPI 1760567168

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 21

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 21

Affiliated clinicians 136

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

View all 136

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1306921887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 EAST UNION ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033246",
            "telephone_number": "662-378-3783",
            "fax_number": "662-725-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EAST UNION ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033246",
            "telephone_number": "662-378-3783",
            "fax_number": "662-725-2289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 S Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "MS",
            "postal_code": "387014719",
            "country_code": "US",
            "telephone_number": "662-378-3783",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DELTA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "STACKER",
        "authorized_official_first_name": "IRIS",
        "authorized_official_middle_name": "Y.",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "662-725-2099",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RHIA"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MS",
            "license": "11-189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "000020145",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000020145",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Health-The Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Delta Regional Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Delta Regional Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Greenville, MS

Sources for this page

Verify at the official NPI Registry.