DEDRI M IVORY MD PLLC
NPI 1508229378
Internal Medicine - Rheumatology in Vicksburg, MS
About Dedri M Ivory Md Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEDRI M IVORY MD PLLC (NPI 1508229378) is a healthcare organization registered as a rheumatology in Vicksburg, Mississippi and active in the NPI registry since March 2016. The organization holds a CLIA Waiver certificate valid through April 14, 2028 and lists Dedri M Ivory, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 3
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dedri M Ivory Md Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Dedri M Ivory MD PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 25D2111796
River City Medical And Arthritis Center LLC · Vicksburg, MSFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is River City Medical And Arthritis Center LLC's NPI number?
The NPI number for River City Medical And Arthritis Center LLC is 1508229378. It was assigned to this organization in the NPPES registry on March 30, 2016. The provider is doing business as Dedri M Ivory MD PLLC.
Where is River City Medical And Arthritis Center LLC located?
River City Medical And Arthritis Center LLC is located at 3510 Pemberton Square Blvd, Vicksburg, MS 39180. The listed phone number is (601) 501-6991.
What is River City Medical And Arthritis Center LLC's specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.
Is River City Medical And Arthritis Center LLC enrolled in Medicare?
Yes. River City Medical And Arthritis Center LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through River City Medical And Arthritis Center LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to River City Medical And Arthritis Center LLC, in Nurse Practitioner and Rheumatology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does River City Medical And Arthritis Center LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D2111796) is associated with this NPI, valid through April 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does River City Medical And Arthritis Center LLC accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list River City Medical And Arthritis Center LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for River City Medical And Arthritis Center LLC was last updated on January 13, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dedri M Ivory Md Pllc · NPI 1508229378
Rheumatology organization in Vicksburg, Mississippi. Organization record, active in the CMS NPPES registry since March 30, 2016.
## Identity
- **NPI:** 1508229378 (Entity type: Organization)
- **Enumerated:** March 30, 2016
- **Primary specialty:** Internal Medicine - Rheumatology · taxonomy 207RR0500X
- **Legal business name:** River City Medical And Arthritis Center Llc
- **Organization subpart:** No
- **Authorized official:** Dedri Ivory, OWNER
## Practice location
- **Address:** 3510 PEMBERTON SQUARE BLVD, Vicksburg, MS 39180-5506
- **Phone:** (601) 501-6991 · **Fax:** (601) 501-6987
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (1), Rheumatology (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 13, 2017
- **Other identifiers:** Medicaid 08551324 (MS); Medicare PIN 529419; Medicare PIN 529450ZWJH
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1508229378) · Data from the CMS NPPES public registry.