Organization Active NPI

Southeastern Retina Associates, P.C.

  • Retina Specialist (Ophthalmology) Physician
  • Hixson, TN
National Provider Identifier
1104097310
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
SOUTHEASTERN RETINA ASSOCIATES, P.C.
Practice address
1961 Northpoint Blvd Ste 110
Hixson, TN 37343-4556
Phone
(423) 756-1002
NPI assigned
Mar 14, 2008
Last updated
Nov 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Authorized official

Name
Andrew Laverghetta
Title
Ceo
Phone
(865) 474-7596

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

1961 Northpoint Blvd Ste 110
Hixson, TN 37343-4556

Mailing address

9050 Executive Park Dr Ste 202a
Knoxville, TN 37923-4670
Phone (865) 588-0811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000507 TN Part B Supplier - Clinic/Group Practice 7517862360 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
Practice locations: Knoxville, TN; Sevierville, TN; Powell, TN; Oak Ridge, TN; Morristown, TN; Maryville, TN; Kingston, TN; Kingsport, TN…
O20040528000049 GA Part B Supplier - Clinic/Group Practice 7517862360 Receives reassigned benefits from 6 practitioners
Practice locations: Dalton, GA; Rome, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2095252Southeastern Retina Associates1961 Northpoint Blvd, Ste 110, Hixson, TN 37343Certificate of waiverMay 3, 2027

National Provider Directory

National Provider Directory

Locations

2202 Jordan Rd SW
Ste 500
Fort Payne, AL 35968
Phone (205) 997-2820

1008 Professional Blvd
Ste 5
Dalton, GA 30720
Phone (706) 370-5030

1606 Gunbarrel Rd
Ste 1
Chattanooga, TN 37421

1949 Gunbarrel Rd
Ste 165
Chattanooga, TN 37421

7268 Jarnigan Rd
Ste 300
Chattanooga, TN 37421
Phone (423) 664-3366

123 S Jefferson Ave
Cookeville, TN 38501
Phone (931) 526-7581

1855 Tanner Way
Ste 120
Harriman, TN 37748
Phone (865) 882-1535

100 Med Tech Pkwy
#140
Johnson City, TN 37604
Phone (423) 434-0853

110 Med Tech Pkwy
Ste 2
Johnson City, TN 37604
Phone (423) 722-0371

2205 Pavilion Dr
Ste 204
Kingsport, TN 37660
Phone (828) 264-0042

140 Capital Dr
Ste 2A
Knoxville, TN 37922

1928 Alcoa Hwy
Knoxville, TN 37920
Phone (865) 305-8787

888171 Box
Knoxville, TN 37995

9050 Executive Park Dr
Ste 2024
Knoxville, TN 37923

628 Smithview Dr
Maryville, TN 37803
Phone (865) 984-7012

1447 W Morris Blvd
Ste C
Morristown, TN 37813
Phone (423) 581-1271

3101 W Andrew Johnson Hwy
Morristown, TN 37814

575 Oak Ridge Tpke
Ste 202
Oak Ridge, TN 37830
Phone (865) 482-3127

1701 Euclid Ave
Ste A
Bristol, VA 24201

185 Gate City Hwy
Bristol, VA 24201

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1104097310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9050 EXECUTIVE PARK DR STE 202A",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234670",
            "telephone_number": "865-588-0811",
            "fax_number": "865-934-3892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1961 NORTHPOINT BLVD STE 110",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434556",
            "telephone_number": "423-756-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RETINA ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "LAVERGHETTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "865-474-7596"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hixson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.