NPIMap

Organization Active NPI

Missouri Delta Medical Center

Doing business as Community Care Center

  • Rural Health Clinic/Center
  • Charleston, MO
National Provider Identifier
1790855401
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
100-49 Issued in MO
Legal business name
MISSOURI DELTA MEDICAL CENTER
Doing business as
Community Care Center
Practice address
1403 E Marshall St
Charleston, MO 63834-1446
Phone
(573) 683-2327
Fax
(573) 683-2373
NPI assigned
Nov 9, 2006
Last updated
Apr 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSOURI DELTA MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 100-49 MO Primary

Addresses

Primary practice location

1403 E Marshall St
Charleston, MO 63834-1446

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
010418903MedicaidMO

Other names 1

  • Community Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100617000860 MO Part A Provider - Rural Health Clinic 1355252891 Practice locations: Charleston, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790855401. Details of each certification follow.

Rural health clinic certification: CCN 263492

Legal name
MISSOURI DELTA MEDICAL CENTER
Doing business as
COMMUNITY CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 23, 1996
Last certification
Mar 2, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
1403 E Marshall St
Charleston, MO 63834-1446
Related CCNs
260113

Facilities connected through Provider of Services related, parent or unit certification numbers.

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0927071Missouri Delta Community Care Center1403 East Marshall, Charleston, MO 63834Certificate of waiverJun 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
D Link Crna27 organizations share this tax ID, including this one
Part of
D Link Crna

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Jason M Schrumpf Individual Corporate OfficerCeo Jan 1, 2021
Corporate DirectorCeo Jan 1, 2021
W-2 Managing EmployeeCeo Jan 1, 2021
Bartholomew Grant Individual Corporate DirectorBoard Member Jan 12, 2016
Britton McConnell Individual Corporate DirectorBoard Member Jan 8, 2008
James D Henson Individual Corporate OfficerCoo Jan 1, 2021
Corporate DirectorCoo Jan 1, 2021
W-2 Managing EmployeeCoo Jan 1, 2021
Missouri Delta Medical Center Organization, Sikeston, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 23, 1996 100%
Robert M Macgillivray Individual Corporate DirectorBoard Member Jan 8, 2008
David Jones Individual Corporate DirectorBoard Member Jan 14, 2020
Brian Menz Individual Corporate DirectorBoard Member Jan 11, 2000
Michael Jones Individual Corporate DirectorBoard Member Jan 12, 2010
Daniel Lape Individual Corporate DirectorBoard Member Jan 12, 2016
Julie Aycock Individual Corporate DirectorBoard Member Jan 12, 2021
Dwight Bizzell Individual Corporate DirectorBoard Member Jan 10, 2017
Edward E Dement Individual Corporate DirectorBoard Member Jan 12, 2010
Michael Marshall Individual Corporate DirectorBoard Member Jan 8, 2019
John Bollinger Individual Corporate DirectorBoard Member Jan 11, 2011
Tammy Burch Individual Corporate DirectorBoard Member Jan 8, 2019
Charles D Jennings Individual Corporate Officer Jan 14, 2014
Brett Matthews Individual Corporate DirectorBoard Member Jan 14, 2020
Elizabeth M Johnson Individual Corporate DirectorBoard Member Jan 8, 2008
Jeff Partridge Individual Corporate DirectorBoard Member Jan 14, 2014
Gregory Carda Individual Corporate Director Jan 27, 2015
W-2 Managing Employee Jan 27, 2015
Leven Cox Individual Corporate DirectorBoard Member Jan 10, 2017
Matthew Tanner Individual Corporate DirectorBoard Member Jan 12, 2016
Matthew Drake Individual Corporate DirectorBoard Member Jan 14, 2020
Joel Evans Individual Corporate DirectorBoard Member Jan 12, 2016

Owners & managing parties with NPI records 17

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

View all 17

All facility ownership & control disclosures 12

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
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 12

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

Facilities with the same owner 12

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776211200000",
    "number": "1790855401",
    "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": "1403 E MARSHALL ST",
            "city": "CHARLESTON",
            "state": "MO",
            "postal_code": "638341446",
            "telephone_number": "573-683-2327",
            "fax_number": "573-683-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI DELTA MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSOURI DELTA MEDICAL CENTER",
        "enumeration_date": "2006-11-09",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "100-49",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010418903",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, MO

Sources for this page

Verify at the official NPI Registry.