NPIMap

Organization Active NPI

South Sunflower County Hospital

  • Family Nurse Practitioner
  • Indianola, MS
National Provider Identifier
1336706803
Registry record updated May 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
SOUTH SUNFLOWER COUNTY HOSPITAL
Practice address
121 E Baker St
Indianola, MS 38751-2450
Phone
(662) 635-7210
Fax
(662) 887-4111
NPI assigned
May 21, 2019
Last updated
May 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2019

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

Authorized official

Name
Courtney Phillips
Title
Ceo
Phone
(662) 635-7200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X NU
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

121 E Baker St
Indianola, MS 38751-2450

Mailing address

121 E Baker St
Indianola, MS 38751-2450
Phone (662) 635-7210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 8

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

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1558396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558396800000",
    "number": "1336706803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E BAKER ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512450",
            "telephone_number": "662-635-7210",
            "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": "662-635-7210",
            "fax_number": "662-887-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SUNFLOWER COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-21",
        "last_updated": "2019-05-21",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-635-7200"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianola, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.