Robert Joseph Derveloy III, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

12390 Issued in MS

Practice address

830 S Gloster St
NMMC East Tower 4TH Floor
Tupelo, MS 38801-4934

Phone

(662) 377-7170

Fax

(662) 377-2423

NPI assigned

Jul 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Mississippi Medical Center Inc

  • Psychologist
  • Tupelo, MS
  • NPI 1972608347
  Medicare reassignment NPD
• North Mississippi Medcial Center, Inc.

  • Diagnostic Radiology Physician
  • Tupelo, MS
  • NPI 1902762487
  NPD
• North Mississippi Medical Center, Inc.

  • Pulmonary Disease Physician
  • Tupelo, MS
  • NPI 1881064517
  NPD
• Cardiothoracic Surgery Clinic of North Ms

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Tupelo, MS
  • NPI 1154533321
  NPD (past)

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1689674707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7062",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388027062",
            "telephone_number": "662-377-7170",
            "fax_number": "662-377-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER ST",
            "address_2": "NMMC EAST TOWER 4TH FLOOR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014934",
            "telephone_number": "662-377-7170",
            "fax_number": "662-377-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERVELOY",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MS",
            "license": "12390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "730-10331",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118384",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Omar Demachkie
• Stephanie Denton, LPN
• Nivea M Depriest, LMSW
• Abyot Dereje, MD
• Dermatology Center of North Ms PA
• Jigar Rameshbhai Desai, DO
• Chloe Devaughn
• Jeffrey Dews
• Jayant Dey, MD
• DHP of North Mississippi Professional Association

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.