NPIMap

Organization Active NPI

North Sunflower Medical Center

Doing business as Cleveland Medical Clinic

  • Family Medicine Physician
  • Cleveland, MS
National Provider Identifier
1891705133
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH SUNFLOWER MEDICAL CENTER
Doing business as
Cleveland Medical Clinic
Practice address
810 E Sunflower Rd
Suite 100-a
Cleveland, MS 38732-2800
Phone
(662) 843-3606
Fax
(662) 846-1194
NPI assigned
Aug 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Tommicile C Rogers
Title
Office Manager
Phone
(662) 843-3606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

810 E Sunflower Rd
Suite 100-a
Cleveland, MS 38732-2800

Mailing address

810 E Sunflower Rd
Suite 100-a
Cleveland, MS 38732-2800
Phone (662) 843-3606

Other names 1

  • Cleveland Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041123000318 MS Part B Supplier - Clinic/Group Practice 7618932294 Receives reassigned benefits from 109 practitioners
7 other NPIs on this enrollment
Practice locations: Greenwood, MS; Ruleville, MS

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
North Sunflower Medical CenterRuleville, MS, CCN 251318 Hospital Operational/Managerial Control (100%) Oct 1, 2004
Sunflower Rural Health CenterRuleville, MS, CCN 253400 Rural health clinic Operational/Managerial Control Oct 1, 2014
Sunflower Greenwood ClinicGreenwood, MS, CCN 258686 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 31, 2023

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 108

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 108

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891705133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 E SUNFLOWER RD",
            "address_2": "SUITE 100-A",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322800",
            "telephone_number": "662-843-3606",
            "fax_number": "662-846-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E SUNFLOWER RD",
            "address_2": "SUITE 100-A",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322800",
            "telephone_number": "662-843-3606",
            "fax_number": "662-846-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUNFLOWER MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "TOMMICILE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-843-3606",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleveland Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, MS

Sources for this page

Verify at the official NPI Registry.