NPIMap

Organization Active NPI

Delta Medical Foundation

Doing business as Family Medical Center

  • Rural Health Clinic/Center
  • Marks, MS
National Provider Identifier
1720585490
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DELTA MEDICAL FOUNDATION
Doing business as
Family Medical Center
Practice address
1024 Martin Luther King Dr
Marks, MS 38646-1832
Phone
(662) 326-3502
Fax
(662) 326-2555
NPI assigned
Apr 10, 2018
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Lonnie MooreNPI 1962852988
Title
Executive Director
Phone
(662) 326-3500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

1024 Martin Luther King Dr
Marks, MS 38646-1832

Mailing address

PO Box 289
Marks, MS 38646-0289
Phone (662) 326-3502

Other names 1

  • Family Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180618001135 MS Part B Supplier - Clinic/Group Practice 2163777046 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksdale, MS; Marks, MS
O20180720000274 MS Part A Provider - Rural Health Clinic 2163777046 Practice locations: Marks, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720585490. Details of each certification follow.

Rural health clinic certification: CCN 253818

Legal name
DELTA MEDICAL FOUNDATION
Doing business as
FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 20, 2018
Last certification
Jan 19, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 2018 in MS
Enrollment address
1024 Martin Luther King Dr
Marks, MS 38646-1832

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Delta Medical Foundation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Jameye Murphree Individual Corporate DirectorAdministrator Jul 1, 2022 100%
W-2 Managing EmployeeAdministrator Jul 1, 2022 100%
Operational/Managerial ControlAdministrator Jul 1, 2022 100%
Delta Medical Foundation Organization, Marks, MS Corporation, Management services company, For-profit 5% Or Greater Direct Ownership Interest Feb 13, 2018 100%
Operational/Managerial Control Jan 1, 2018 100%
Sonya Walters Individual Corporate DirectorCfo Jan 1, 2022 100%
W-2 Managing EmployeeCfo Jan 1, 2022 100%
Operational/Managerial ControlCfo Jan 1, 2022 100%
Robert Waller Individual Corporate DirectorMedical Director Apr 1, 2018 100%
W-2 Managing EmployeeMedical Director Apr 1, 2018 100%
Lonnie L Moore Individual Corporate DirectorDirector Sep 1, 2018 100%
W-2 Managing EmployeeDirector Sep 1, 2018 100%
Operational/Managerial ControlDirector Sep 1, 2018 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Warrington ClinicClarksdale, MS, CCN 258991 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 13, 2018
Apr 1, 2018

Owned or controlled facilities with NPI records 1

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

  • Delta Medical Foundation

    dba Warrington Clinic

    • Rural Health Clinic/Center
    • Clarksdale, MS
    • NPI 1508363060

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1720585490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 289",
            "city": "MARKS",
            "state": "MS",
            "postal_code": "386460289",
            "telephone_number": "662-326-3502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 MARTIN LUTHER KING DR",
            "city": "MARKS",
            "state": "MS",
            "postal_code": "386461832",
            "telephone_number": "662-326-3502",
            "fax_number": "662-326-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-10",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LONNIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-326-3500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marks, MS

Sources for this page

Verify at the official NPI Registry.