Jerry Ross Adkins, M.D.
Individual provider Active NPI Family Medicine Physician · D'Ilberville, MS
NPI 1760426563 · NPPES record last updated Feb 1, 2018
Key facts
- NPI
- 1760426563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 04305 (MS)
- Practice address
- 11516 Lamey Bridge Road Ste 1
D'Ilberville, MS 39340 - Phone
- (228) 207-4190
- Fax
- (228) 207-4156
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080324000475 | MS | Practitioner - General Surgery | 7719063320 |
Reassigns benefits to 1 organization Practice locations: Diberville, MS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04305 | MS | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Mississippi Urgent Care | Current |
Accepting new patients | |
| Biloxi Hma Inc | Past | Accepting new patients | |
| Biloxi Hma Physician Management LLC | Past | Accepting new patients | |
| D'Iberville Medical Clinic LLC | Family Medicine | Past |
Accepting new patients |
Locations
3661 Sangani Blvd
Ste E
Diberville, MS 39540
Phone (228) 354-0022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 04305 | MS | |
| Family Medicine Physician | 207Q00000X | 04305 | MS | Yes |
Addresses
Primary practice location
11516 Lamey Bridge Road Ste 1
D'Ilberville, MS 39340
Mailing address
PO Box 1277
Biloxi, MS 39533
Phone (228) 207-4190
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00012155 | Medicaid | MS |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.