David McInnis Berry – Emergency Medicine Physician

Key facts

NPI: 1992024459
Entity type: Individual (NPI type 1)
Primary specialty: Emergency Medicine Physician 207P00000X
License: 21038 (MS)
Practice address: 270 W. Main St.
Centreville, MS 39631-0639
Phone: (601) 645-5221
NPI assigned: May 24, 2010
Sex: Male
Sole proprietor: No

Organizations & group practices 5

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.

Pontotoc Health Services, Inc. Critical Access Hospital · Pontotoc, MS · NPI 1821103516

Medicare reassignment NPD MS
Tallahatchie General Hospital Critical Access Hospital · Charleston, MS · NPI 1679733497

Medicare reassignment NPD MS
Pontotoc Health Services, Inc. Critical Access Hospital · Pontotoc, MS · NPI 1962512871

NPD
Tallahatchie General Hospital Diagnostic Radiology Physician · Charleston, MS · NPI 1215267232

NPD
McLemore Emergency Physicians Emergency Medicine Physician · Meridian, MS · NPI 1427007483

NPD (past) EMERGENCY MEDICINE

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in MS, CO
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
I20110118000882	MS	Practitioner - Emergency Medicine	5597954834	Reassigns benefits to 3 organizations
I20200805003271	CO	Practitioner - General Practice	5597954834

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
21038	MS	MD	Emergency Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Pontotoc Health Services, Inc.		Current since Feb 1, 2011	Accepting new patients
Tallahatchie General Hospital		Current since Jul 22, 2015	Accepting new patients
Tallahatchie General Hospital		Current since Jul 22, 2015	Accepting new patients
Pontotoc Health Services, Inc.		Current since Feb 1, 2011	Accepting new patients
McLemore Emergency Physicians	Emergency Medicine	Past since Dec 18, 2007	Accepting new patients

Locations

1301 Sunset Dr
Ste E
Grenada, MS 38901
Phone (662) 229-0069

176 S Main St
Pontotoc, MS 38863
Phone (601) 489-5510

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	21038	MS
Emergency Medicine Physician	207P00000X	21038	MS	Yes

Addresses

Primary practice location

270 W. Main St.
Centreville, MS 39631-0639

Mailing address

5201 Lakeland Blvd
B 12
Flowood, MS 39232-8912
Phone (601) 853-2626

Other practice location 1

390 Yampa Boulevard
Craig, CO 81625
Phone (970) 824-5433

Other identifiers

Identifier	Type	State	Issuer
06439090	Medicaid	MS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 25, 2020.

{
    "created_epoch": "1274659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1992024459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 LAKELAND BLVD",
            "address_2": "B 12",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328912",
            "telephone_number": "601-853-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 W. MAIN ST.",
            "city": "CENTREVILLE",
            "state": "MS",
            "postal_code": "396310639",
            "telephone_number": "601-645-5221"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "390 Yampa Boulevard",
            "address_purpose": "LOCATION",
            "city": "Craig",
            "state": "CO",
            "postal_code": "81625",
            "country_code": "US",
            "telephone_number": "970-824-5433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERRY",
        "first_name": "DAVID",
        "middle_name": "MCINNIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-24",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "21038",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "21038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06439090",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, MS

All providers in Centreville, MS · Emergency Medicine Physician in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2020. 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.

Verify at the official NPI Registry.