NPIMap

Organization Active NPI

Mid South Retina Associates, LLC

  • Ophthalmology Physician
  • Blytheville, AR
National Provider Identifier
1316973076
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MID SOUTH RETINA ASSOCIATES, LLC
Practice address
529 N 10TH St
Blytheville, AR 72315-1974
Phone
(870) 762-1942
Fax
(901) 682-1100
NPI assigned
Jun 24, 2006
Last updated
Feb 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MID-SOUTH RETINA ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Authorized official

Name
Dr. Richard Sievers, M.D.NPI 1962407791
Title
Partner
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 Primary

Addresses

Primary practice location

529 N 10TH St
Blytheville, AR 72315-1974

Mailing address

PO Box 1000 Dept 448
Memphis, TN 38148-0448
Phone (870) 762-1942

Other identifiers 2

IdentifierTypeStateIssuer
158632001MedicaidAR
5C535OtherARBLUE CROSS OF ARKANSAS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602001396 AR Part B Supplier - Clinic/Group Practice 8921080094 Receives reassigned benefits from 3 practitioners
Practice locations: Blytheville, AR; Jonesboro, AR

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Mid South Retina Associ8 organizations share this tax ID, including this one
Part of
Mid South Retina Associ

Other organizations with this tax ID 7

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

Locations

411 W Washington Ave
Ste C
Jonesboro, AR 72401

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1316973076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000 DEPT 448",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480448",
            "telephone_number": "870-762-1942",
            "fax_number": "901-682-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 N 10TH ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151974",
            "telephone_number": "870-762-1942",
            "fax_number": "901-682-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID SOUTH RETINA ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID-SOUTH RETINA ASSOCIATES, LLC",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "SIEVERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "901-682-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158632001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ARKANSAS",
            "identifier": "5C535",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blytheville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.