D'Iberville Medical Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

D'IBERVILLE MEDICAL CLINIC LLC

Practice address

11516 Lamey Bridge Rd
Ste 1
Diberville, MS 39540-2725

Phone

(228) 207-4190

Fax

(228) 207-4190

NPI assigned

Mar 5, 2019

Last updated

May 2, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jerry R AdkinsNPI 1760426563

Title

Administrator

Phone

(228) 861-6049

Specialties & licenses 1

Addresses

Locations

Practitioners 4

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.

• Jerry Ross Adkins, M.D.

  • Family Medicine Physician
  • D'Ilberville, MS
  • NPI 1760426563
  NPD (past) Authorized official
• Carla Diane Diffenderfer, FNP

  • Family Nurse Practitioner
  • D'Iberville, MS
  • NPI 1467880922
  NPD (past)
• Brian Raymond Pitre, M.D.

  • Surgery Physician
  • Ocean Springs, MS
  • NPI 1295779007
  NPD (past)
• Courtney Leigh Ponder, APRN

  • Family Nurse Practitioner
  • Ocean Springs, MS
  • NPI 1568948016
  NPD (past)

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

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1629536925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1277",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395331277",
            "telephone_number": "228-207-4190",
            "fax_number": "228-207-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11516 LAMEY BRIDGE RD",
            "address_2": "STE 1",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395402725",
            "telephone_number": "228-207-4190",
            "fax_number": "228-207-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D'IBERVILLE MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "ADKINS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "228-861-6049",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Cothern, PHARM D
• Keely Cox, OD
• Angela Crocker, RBT
• Lindsey Rachelle Cuevas, PHARMD
• D'Iberville Chiropractic Clinic, Inc.
• Andrea L Davis, D.D.S.
• Diberville Medical Spa
• Carla Diane Diffenderfer, FNP
• Shekina T Dillon, NURSE PRACTITIONER
• Sarah Sage Dolbear, M.D

• Family Medicine Physician in D'Iberville, MS
• Providers in D'Iberville, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.