Southeastern Retina Specialists, PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME0064370 Issued in FL

Legal business name

SOUTHEASTERN RETINA SPECIALISTS, PA

Practice address

7740 Point Meadows Dr
Suite 3a
Jacksonville, FL 32256-9179

Phone

(904) 527-3577

Fax

(904) 527-3514

NPI assigned

May 14, 2015

Last updated

Jul 6, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Shannon Delp, OCS

Title

Practice Administrator

Phone

(904) 527-3577

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

Enrollment records 2

Locations

Interoperability endpoints

• Direct secure messaging: jsullivan@southeasternretina.intellechartdirect.net
• Direct secure messaging: sagee@southeasternretina.intellechartdirect.net

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.

• Shawn Agee, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Jacksonville, FL
  • NPI 1114247079

  GA

  Medicare reassignment Care Compare group NPD
• John P Sullivan, MD

  • Ophthalmology Physician
  • Jacksonville, FL
  • NPI 1619977345

  GA

  Medicare reassignment Care Compare group NPD
• Robert Gregory Lee, M.D.

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1811910375
  NPD (past)
• Pauline Marie Bellecci, M.D.

  • Internal Medicine Physician
  • Folkston, GA
  • NPI 1457314742
  NPD (past)

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436140800000",
    "number": "1427436187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7740 POINT MEADOWS DR",
            "address_2": "SUITE 3A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569179",
            "telephone_number": "904-527-3577",
            "fax_number": "904-527-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7740 POINT MEADOWS DR",
            "address_2": "SUITE 3A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569179",
            "telephone_number": "904-527-3577",
            "fax_number": "904-527-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RETINA SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2015-07-06",
        "status": "A",
        "authorized_official_last_name": "DELP",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-527-3577",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OCS"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME0064370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeastern Hand Rehabilitation Inc (Reist Hand Therapy)
• Southeastern Hand Rehabilitation Inc. (Reist Hand Therapy)
• Southeastern Hearing Inc. (Clear Ear)
• Southeastern Neuroscience Institute PA
• Southeastern Pharmacy
• Cordecia Deshanae Southerland
• Nancy Southerland
• Southern Baptist Hospital (Psychiatric and Psychological Care)
• Southern Baptist Hospital (Psychiatric and Psychological Care)
• Southern Baptist Hospital of Florida Inc (Baptist Medical Center)

• Ophthalmology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; 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.