DEDRI M IVORY MD PLLC
NPI 1508229378
Internal Medicine - Rheumatology in Vicksburg, MS
NPI Status: Active since March 30, 2016
Contact Information
3510 PEMBERTON SQUARE BLVD
VICKSBURG, MS
ZIP 39180
Phone: (601) 501-6991
Fax: (601) 501-6987
- Organization
- Internal Medicine
- Rheumatology
- Accepts Insurance
- CLIA Number: 25D2111796
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-14-2028
About DEDRI M IVORY MD PLLC
This page provides the complete NPI Profile along with additional information for Dedri M Ivory Md Pllc, an internist established in Vicksburg, Mississippi operating as a Internal Medicine, focusing in rheumatology . The healthcare provider is registered in the NPI registry with number 1508229378 assigned on March 2016. The practitioner's primary taxonomy code is 207RR0500X with license number 21520 (MS). The provider is registered as an organization and their NPI record was last updated 9 years ago. Dedri M Ivory Md Pllc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Dedri M Ivory Md Pllc. The authorized official of this NPI record is Dr. Dedri M Ivory Md (Owner)
- NPI
- 1508229378
- Provider Legal Name
- RIVER CITY MEDICAL AND ARTHRITIS CENTER LLC
- Other Organization Name
- DEDRI M IVORY MD PLLC
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 3510 PEMBERTON SQUARE BLVD VICKSBURG, MS 39180
- Location Phone
- (601) 501-6991
- Location Fax
- (601) 501-6987
- Mailing Address
- 3510 PEMBERTON SQUARE BLVD VICKSBURG, MS 39180
- Mailing Phone
- (601) 501-6991
- Mailing Fax
- (601) 501-6987
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-30-2016
- Last Update Date
- 01-13-2017
- Code Navigator
An internist like Dedri M Ivory Md Pllc is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine Rheumatology
- Taxonomy Code
- 207RR0500X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 21520
- License State
- MS
- Taxonomy Description
- An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA (QualChoice) - POS
- Complete Gold - PPO
- Complete Gold + Vision + Adult Dental - PPO
- Connected Silver - PPO
- Connected Silver (QualChoice) - POS
- Connected Silver (QualChoice) + Vision + Adult Dental - POS
- Connected Silver (QualChoiceLife) - PPO
- Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
- Connected Silver + Vision + Adult Dental - PPO
- Elite Bronze - PPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Standard Expanded Bronze - HMO
- Standard Expanded Bronze + Vision + Adult Dental - HMO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Molina Gold Standard - HMO
- Molina Silver Standard - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 08551324 | MEDICAID (05) | MS | |
| 529419 | MEDICARE PIN (08) | ||
| 529450ZWJH | MEDICARE PIN (08) |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 25D2111796
- Facility Type
- Physician Office
- Certificate Effective Date
- April 15, 2026
- Certificate Expiration Date
- April 14, 2028
- Laboratory Director
- DR. DEDRI M. IVORY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Dedri M Ivory Md Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1508229378, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 62. The final step is to find the difference between that total and the next multiple of ten (70 - 62 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 62 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
VICKSBURG, MS 39180
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1508229378, enumerated as an "organization" on March 30, 2016.
The provider is located at 3510 PEMBERTON SQUARE BLVD VICKSBURG, MS 39180 and the phone number is (601) 501-6991.
Internal Medicine with taxonomy code 207RR0500X and a focus in Rheumatology.
The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to verify.
