Active NPI
Southeastern Retina Associates, P.C.
- Retina Specialist (Ophthalmology) Physician
- Hixson, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Retina Specialist (Ophthalmology) Physician
- 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, 2025
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | |||
| Retina Specialist (Ophthalmology) Physician | 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, GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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).
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1932200664
7517862360
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1932200664
O20031204000507
-
- Retina Specialist (Ophthalmology) Physician
- Kingsport, TN
- NPI 1932370145
O20031204000507
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2095252 | Southeastern Retina Associates | Certificate of waiver | May 3, 2027 |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1972509297
-
- Ophthalmology Physician
- Knoxville, TN
- NPI 1609137595
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1811387061
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1811421555
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1477791143
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1023014347
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1710983721
-
- Retina Specialist (Ophthalmology) Physician
- Knoxville, TN
- NPI 1427054436
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
- Ellen Pigott Soufleris
- Garrett C Soulen, DDS
- Southeast Senior Services LLC.
- Southeast Vision Rehabilitation, PLLC
- Southeastern Dental Associates of Hixson
- Southern Eyecare Associates Inc
- Lauren Taylor Souza, PA-C, DMS, MSW
- Amanda Yvette Sovago-Royal, LMT
- Specialized Oxygen Services, LLC
- Owen F Speer, DO
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.