River City Medical and Arthritis Center LLC

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

21520 Issued in MS

Legal business name

RIVER CITY MEDICAL AND ARTHRITIS CENTER LLC

Practice address

3510 Pemberton Square Blvd
Vicksburg, MS 39180-5506

Phone

(601) 501-6991

Fax

(601) 501-6987

NPI assigned

Mar 30, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Dedri M Ivory, MDNPI 1851585004

Title

Owner

Phone

(601) 501-6991

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dedri M Ivory MD PLLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dedri Markita Ivory, M.D.

  • Rheumatology Physician
  • Vicksburg, MS
  • NPI 1851585004
  Medicare reassignment Care Compare group NPD Authorized official
• Barbara J Phelps

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1205932134
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1508229378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805506",
            "telephone_number": "601-501-6991",
            "fax_number": "601-501-6987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805506",
            "telephone_number": "601-501-6991",
            "fax_number": "601-501-6987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY MEDICAL AND ARTHRITIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "IVORY",
        "authorized_official_first_name": "DEDRI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-501-6991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MS",
            "license": "21520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08551324",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedri M Ivory MD PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Audrey Richardson
• Ashley Turner Riggs
• River City Chiropractic Clinic LLC
• River City Dermatology and Aesthetics LLC
• River City Family Medicine and Weight Management Clinic, LLC
• River Oaks Management Company, LLC
• River Physicians Group, LLC
• River Region Health System
• River Region Health System
• Riverbend Eyecare, P.a.

• Rheumatology Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Rheumatology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.