NPIMap

Organization Active NPI

Delta Health System

Doing business as Delta Health-Medical Group (Anesthesia)

  • Anesthesiology Physician
  • Greenville, MS
National Provider Identifier
1447818026
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
DELTA HEALTH SYSTEM
Doing business as
Delta Health-Medical Group (Anesthesia)
Practice address
1400 E Union St
Greenville, MS 38703-3246
Phone
(662) 378-3783
Fax
(662) 725-2189
NPI assigned
May 30, 2019
Last updated
Nov 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DELTA HEALTH SYSTEMAs reported in NPPES

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
Iris Stacker
Title
Ceo
Phone
(662) 725-2020

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1400 E Union St
Greenville, MS 38703-3246

Mailing address

PO Box 5247
Greenville, MS 38704-5247
Phone (662) 725-2740

Other practice location 1

1970 Hospital Dr
Clarksdale, MS 38614-7202
Phone (662) 627-3211

Other practice location 2

401 Getwell Dr
Senatobia, MS 38668-2213
Phone (662) 501-9641

Other names 1

  • Delta Health-Medical Group (Anesthesia) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210812003936 MS Part B Supplier - Clinic/Group Practice 9830593821 Receives reassigned benefits from 32 practitioners
Practice locations: Clarksdale, MS; Greenville, MS

National Provider Directory

National Provider Directory
Tax ID family
Delta Health System2 organizations share this tax ID, including this one
Part of
Delta Medical Center

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1447818026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5247",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387045247",
            "telephone_number": "662-725-2740",
            "fax_number": "662-725-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E UNION ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033246",
            "telephone_number": "662-378-3783",
            "fax_number": "662-725-2189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1970 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Clarksdale",
            "state": "MS",
            "postal_code": "386147202",
            "country_code": "US",
            "telephone_number": "662-627-3211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 Getwell Dr",
            "address_purpose": "LOCATION",
            "city": "Senatobia",
            "state": "MS",
            "postal_code": "386682213",
            "country_code": "US",
            "telephone_number": "662-501-9641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DELTA HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DELTA HEALTH SYSTEM",
        "enumeration_date": "2019-05-30",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "STACKER",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-725-2020"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Health-Medical Group (Anesthesia)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; 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.