NPIMap

Organization Active NPI

Missouri Delta Medical Center

  • Internal Medicine Physician
  • Sikeston, MO
National Provider Identifier
1508967860
Registry record updated Mar 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MISSOURI DELTA MEDICAL CENTER
Practice address
1008 N Main St
Sikeston, MO 63801-5044
Phone
(573) 471-1600
NPI assigned
Sep 26, 2006
Last updated
Mar 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2015

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

Authorized official

Name
Jason Schrumpf
Title
Ceo/President
Phone
(573) 472-7601

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Nuclear Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207UN0901X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

1008 N Main St
Sikeston, MO 63801-5044

Mailing address

1008 N Main St
Sikeston, MO 63801-5044
Phone (573) 471-1600

Other identifiers 1

IdentifierTypeStateIssuer
506033505MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, MA, NC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040308001306 MO Part B Supplier - Clinic/Group Practice 1355252891 Receives reassigned benefits from 207 practitioners
1 other NPI on this enrollment
Practice locations: Sikeston, MO; Dexter, MO; Cape Girardeau, MO; Benton, MO
O20250331002699 MA Part B Supplier - Clinic/Group Practice 1355252891 Receives reassigned benefits from 1 practitioner
Practice locations: Andover, MA
O20250409002562 NC Part B Supplier - Hospital Department(S) 1355252891 Receives reassigned benefits from 1 practitioner
Practice locations: Raleigh, NC

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

209 W Yoakum Ave
Chaffee, MO 63740
Phone (573) 887-3688

911B W Business US Highway 60
Dexter, MO 63841
Phone (573) 614-5762

811 Main St
Kansas City, MO 64105

412 W Broadwater Rd
Malden, MO 63863
Phone (573) 901-5001

1008 N Main St
Ste 120
Sikeston, MO 63801

1013 N Main St
Sikeston, MO 63801
Phone (573) 472-7535

1017 N Main St
Sikeston, MO 63801
Phone (573) 472-6030

1019 N Main St
Sikeston, MO 63801
Phone (573) 472-7702

1024 N Main St
Sikeston, MO 63801

108 N Main St
Sikeston, MO 63801

1126 N Main St
Sikeston, MO 63801
Phone (573) 471-4312

125 Plaza Dr
Sikeston, MO 63801
Phone (573) 472-7124

135 Plaza Dr
Ste 201
Sikeston, MO 63801
Phone (573) 481-2210

201 Plaza Dr
Ste B
Sikeston, MO 63801
Phone (573) 472-4325

201 Plaza Dr
Ste C
Sikeston, MO 63801
Phone (573) 481-1072

Ownership & related parties

All facility ownership & control disclosures 13

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

FacilityTypeRoleSince
Missouri Delta Medical CenterSikeston, MO, CCN 260113 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2002
Missouri Delta Medical CenterSikeston, MO, CCN 26T113 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 14, 2011
Missouri Delta Medical CenterSikeston, MO, CCN 26S113 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 14, 2011
Missouri Delta Express CareSikeston, MO, CCN 268591 Rural health clinic 5% Or Greater Direct Ownership Interest Sep 16, 2011
Smith Street ClinicSikeston, MO, CCN 268635 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 30, 1966
Community Care CenterCharleston, MO, CCN 263492 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 23, 1996
Portageville Community Care CenterPortageville, MO, CCN 268698 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
New Madrid Community Care CenterNew Madrid, MO, CCN 268699 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Benton Community Care CenterBenton, MO, CCN 268740 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2016
Dexter Community Care CenterDexter, MO, CCN 268739 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
Chaffee Medical ClinicChaffee, MO, CCN 268766 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2017
Malden Primary CareMalden, MO, CCN 268804 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2024
Caruthersville Medical ClinicCaruthersville, MO, CCN 268810 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2025

Owned or controlled facilities with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 227

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 227

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1508967860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 N MAIN ST",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015044",
            "telephone_number": "573-471-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 N MAIN ST",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015044",
            "telephone_number": "573-471-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI DELTA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "SCHRUMPF",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "573-472-7601"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506033505",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sikeston, MO

Sources for this page

Verify at the official NPI Registry.