NPIMap

Organization Active NPI

Mid-South Retina Associates, LLC

  • Ophthalmology Physician
  • Corinth, MS
National Provider Identifier
1235329145
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
18267 Issued in MS
Legal business name
MID-SOUTH RETINA ASSOCIATES, LLC
Practice address
1804 E Shiloh Rd
Corinth, MS 38834-3637
Phone
(731) 427-7799
Fax
(731) 427-1476
NPI assigned
Jul 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Richard Ervin Sievers, M.D.NPI 1962407791
Title
President
Phone
(901) 682-1100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 18267 MS Primary

Addresses

Primary practice location

1804 E Shiloh Rd
Corinth, MS 38834-3637

Mailing address

6005 Park Ave
Suite 624B
Memphis, TN 38119-5202
Phone (901) 682-1100

Other identifiers 1

IdentifierTypeStateIssuer
04635763MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Mid-South Retina Associates LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1235329145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6005 PARK AVE",
            "address_2": "SUITE 624B",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195202",
            "telephone_number": "901-682-1100",
            "fax_number": "901-682-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 E SHILOH RD",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388343637",
            "telephone_number": "731-427-7799",
            "fax_number": "731-427-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-SOUTH RETINA ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "SIEVERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ERVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-682-1100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MS",
            "license": "18267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04635763",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corinth, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.