Southeast Eye Specialists PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

SOUTHEAST EYE SPECIALISTS PLLC

Practice address

28 White Bridge Road
Suite 208
Nashville, TN 37205

Phone

(615) 327-2001

NPI assigned

Apr 29, 2020

Organization subpart

Yes

Parent organization

SOUTHEAST EYE SPECIALISTS, PLLCAs reported in NPPES

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

Authorized official

Name

Stacey Michelle Crudup

Title

Chief Compliance Officer

Phone

(615) 234-0450

Specialties & licenses 7

Addresses

Other identifiers 5

Other names 1

• SouthEast Eye Specialists Middle TN Other name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southeast Eye Specialists PLLC

  • Ophthalmology Physician
  • Chattanooga, TN
  • NPI 1518961176

  O20031103000021

  Same enrollment
• Southeast Eye Specialists, PLLC

  • Ophthalmology Physician
  • Soddy Daisy, TN
  • NPI 1750981189

  O20031103000021

  Same enrollment

Tax ID family

Southeast Eye Specialists PLLC2 organizations share this tax ID, including this one

Part of

Southeast Eye Specialists PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southeast Eye Specialists PLLC

  • Ophthalmology Physician
  • Chattanooga, TN
  • NPI 1518961176
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Southeast Eye Specialists PLLC

  • Ophthalmology Physician
  • Chattanooga, TN
  • NPI 1518961176
  NPPES parent name

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Robert Bierly, MD

  • Ophthalmology Physician
  • Chattanooga, TN
  • NPI 1831193515
  NPD
• John D Bonner, M.D.

  • Ophthalmology Physician
  • Soddy Daisy, TN
  • NPI 1831151216
  NPD
• Daniel K Bregman, M.D.

  • Ophthalmology Physician
  • Nashville, TN
  • NPI 1871529982
  NPD
• Rachel L Brown, OD

  • Optometrist
  • Chattanooga, TN
  • NPI 1013305275
  NPD
• Adam Couts, O.D.

  • Optometrist
  • Gallatin, TN
  • NPI 1144517079
  NPD
• Sachie Hase Craig, O.D.

  • Optometrist
  • Nashville, TN
  • NPI 1518264969
  NPD
• Karen Fitzgerald-Shelton, MD

  • Glaucoma Specialist (Ophthalmology) Physician
  • Murfreesboro, TN
  • NPI 1437136959
  NPD
• Sinead Emily Flood, OD

  • Optometrist
  • Franklin, TN
  • NPI 1659990653
  NPD
• Randall L Funderburk, MD

  • Retina Specialist (Ophthalmology) Physician
  • Chattanooga, TN
  • NPI 1699771931
  NPD
• William M Goodman, MD

  • Ophthalmology Physician
  • Nashville, TN
  • NPI 1689760670
  NPD
• Dahlia Haddad, O.D.

  • Optometrist
  • Goodlettsville, TN
  • NPI 1962852608
  NPD
• Christopher J Haggerty, M.D.

  • Ophthalmology Physician
  • Knoxville, TN
  • NPI 1609883479
  NPD

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1003437138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 COOL SPRINGS BLVD STE 400",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677224",
            "telephone_number": "423-508-7337",
            "fax_number": "423-508-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 WHITE BRIDGE ROAD",
            "address_2": "SUITE 208",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "37205",
            "telephone_number": "615-327-2001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "980 Professional Park Dr Ste E",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370405251",
            "country_code": "US",
            "telephone_number": "615-234-2011",
            "fax_number": "615-234-2015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "342 22nd Ave N",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372031844",
            "country_code": "US",
            "telephone_number": "615-327-2001",
            "fax_number": "615-234-2015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "927 N. James Campbell Blvd.",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "TN",
            "postal_code": "384012755",
            "country_code": "US",
            "telephone_number": "931-840-3501",
            "fax_number": "931-840-3505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "393 Nichol Mill Ln Ste 30",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "TN",
            "postal_code": "370678324",
            "country_code": "US",
            "telephone_number": "615-814-5000",
            "fax_number": "615-814-5001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1602 W Northfield Blvd Ste 504",
            "address_purpose": "LOCATION",
            "city": "Murfreesboro",
            "state": "TN",
            "postal_code": "371296056",
            "country_code": "US",
            "telephone_number": "615-217-3321",
            "fax_number": "615-217-3477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEAST EYE SPECIALISTS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST EYE SPECIALISTS, PLLC",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "CRUDUP",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "615-234-0450"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0009X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Glaucoma Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "524169578A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3721447",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "GRP6156",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRP6156",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "3721447",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthEast Eye Specialists Middle TN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ophthalmology Physician in Nashville, TN
• Providers in Nashville, TN by specialty
• Ophthalmology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.