NPIMap

Organization Active NPI

Delta Health System

Doing business as Delta Health-The Medical Center

  • Rural Health Clinic/Center
  • Greenville, MS
National Provider Identifier
1366592610
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DELTA HEALTH SYSTEM
Doing business as
Delta Health-The Medical Center
Practice address
300 S Washington Ave
Greenville, MS 38701-4719
Phone
(662) 344-9100
Fax
(662) 725-1154
NPI assigned
Jan 11, 2007
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 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 1

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

Addresses

Primary practice location

300 S Washington Ave
Greenville, MS 38701-4719

Mailing address

PO Box 4739
Greenville, MS 38704-4739
Phone (662) 725-2423

Other identifiers 1

IdentifierTypeStateIssuer
09015375MedicaidMS

Other names 3

  • Delta Health-The Medical Center Doing business as
  • Delta Regional Health Clinic Former legal business name
  • Delta Health-The Medical Center (Rural Health) Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050419000915 MS Part A Provider - Rural Health Clinic 0042208787 Practice locations: Greenville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366592610. Details of each certification follow.

Rural health clinic certification: CCN 253461

Legal name
DELTA HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 10, 1996
Last certification
Mar 17, 2022
Ownership / control type
2C
Most recent change of ownership
Mar 31, 2005 (2 total)
Organization structure
GovernmentNon-profit
Incorporated
Oct 1, 1969 in MS
Enrollment address
300 S Washington Ave
Greenville, MS 38701-4719
Related CCNs
250082

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).

National Provider Directory

National Provider Directory
Tax ID family
Delta Med Ctr Cardiolog9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

300 S Washington Ave
Greenville, MS 38701
Phone (662) 378-2020

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Delta Health System Organization, Greenville, MS Non-profit Operational/Managerial Control Jun 10, 1996 100%
Henry Rucker Individual Corporate Director Apr 19, 2005
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

Owners & managing parties with NPI records 6

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

  • Delta Health System

    dba Delta Health Provider Based Clinics

    • Clinic/Center
    • Greenville, MS
    • NPI 1083764542

    Operational/Managerial Control

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

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

    Operational/Managerial Control

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

    • Rural Acute Care Hospital
    • Greenville, MS
    • NPI 1306921887

    Operational/Managerial Control

    CMS ownership
  • Delta Health System

    dba Delta Health - The Medical Center Specialty Pharmacy

    • Community/Retail Pharmacy
    • Greenville, MS
    • NPI 1376930149

    Operational/Managerial Control

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

    • Home Health Agency
    • Greenville, MS
    • NPI 1477651362

    Operational/Managerial Control

    CMS ownership
  • Delta Health System

    dba Delta Health-The Medical Center

    • Rehabilitation Hospital Unit
    • Greenville, MS
    • NPI 1760567168

    Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 3

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

Owned or controlled facilities with NPI records 3

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

    • 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

Facilities with the same owner 3

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

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1366592610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4739",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387044739",
            "telephone_number": "662-725-2423",
            "fax_number": "662-725-2707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S WASHINGTON AVE",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387014719",
            "telephone_number": "662-344-9100",
            "fax_number": "662-725-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015375",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Health-The Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Delta Regional Health Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Delta Regional Health Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Delta Health-The Medical Center (Rural Health)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenville, MS

Sources for this page

Verify at the official NPI Registry.