D'IBERVILLE MEDICAL CLINIC LLC — NPI 1629536925 (Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) in DIBERVILLE, MS)

CMS-1500 Box 24J / 33a • NPI

1629536925

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207Q00000X (CMS 08)

Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)

Box 32 Service Location & ZIP+4

11516 LAMEY BRIDGE RD, STE 1, DIBERVILLE, MS, 39540-2725

✓ 9-Digit EDI 837 ZIP+4 (39540-2725)

Practice Phone & Referral Fax

(228) 207-4190

Fax: (228) 207-4190

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629536925 (D'IBERVILLE MEDICAL CLINIC LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1629536925` (NPI-2 Organization / Facility)
Provider / Legal Name	D'IBERVILLE MEDICAL CLINIC LLC
Plain-English Specialty	Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) NUCC Code: `207Q00000X` (Family Medicine)
Certifying / Licensing Body	American Board of Family Medicine (ABFM)
Practice Location Address	11516 LAMEY BRIDGE RD, STE 1, DIBERVILLE, MS, 39540-2725
Practice Telephone / Fax	Tel: (228) 207-4190 \| Fax: (228) 207-4190
Administrative Mailing Address	PO BOX 1277, BILOXI, MS, 39533-1277
Enumeration & Last Sync	Enumerated: 2019-03-05 \| CMS Record Updated: 2019-05-02
Authorized Official	JERRY ADKINS (Administrator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

11516 LAMEY BRIDGE RD, STE 1, DIBERVILLE, MS, 39540-2725

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Plain-English Taxonomy & CMS Crosswalk (207Q00000X)

What Does Taxonomy Code 207Q00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207Q00000X translates to:
"Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 08 (Physician/Family Practice)
Certifying / Accrediting Authority: American Board of Family Medicine (ABFM)
Clinical Scope: Annual checkups, blood pressure and diabetes management, BMI and fatty liver screening, urinary tract infections, vaccinations, and continuity of care for the whole family.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (D'IBERVILLE MEDICAL CLINIC LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Annual Preventive Physical Examination & Cardiometabolic Screening
Outpatient ECG / EKG Interpretation (CPT 93000) & Ambulatory BP Monitoring
Point-of-Care HbA1c, Lipid Panel, Urinalysis & BMI Risk Stratification
Minor Office Procedures: Wound Suturing, Abscess Drainage & Joint Injections
Adult & Pediatric Immunization Administration (Tetanus/Tdap, Influenza, HPV)

Common Therapeutic Classes:

Metformin, SGLT2 Inhibitors & GLP-1 Receptor Agonists (Type 2 Diabetes)
Lisinopril, Losartan & Amlodipine (First-Line Hypertension Management)
Atorvastatin & Rosuvastatin (Cardiovascular Lipid Optimization)
Nitrofurantoin, Trimethoprim-Sulfamethoxazole & Ciprofloxacin (Outpatient UTIs)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207Q00000X` — Family Medicine Plain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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D'IBERVILLE MEDICAL CLINIC LLC (NPI #1629536925)