Organization Active NPI

Charles Retina Institute PC

  • Specialist
  • Germantown, TN
National Provider Identifier
1477556306
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD8675 Issued in TN
Legal business name
CHARLES RETINA INSTITUTE PC
Practice address
1432 Kimbrough Rd
Germantown, TN 38138-2405
Phone
(901) 767-4499
Fax
(901) 761-0727
NPI assigned
May 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Jennifer Messer
Title
Administrator
Phone
(901) 767-4499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD8675 TN Primary

Addresses

Primary practice location

1432 Kimbrough Rd
Germantown, TN 38138-2405

Mailing address

1432 Kimbrough Rd
Germantown, TN 38138-2405
Phone (901) 767-4499

Other identifiers 1

IdentifierTypeStateIssuer
3158650MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS, AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031108000009 TN Part B Supplier - Clinic/Group Practice 9830002583 Receives reassigned benefits from 11 practitioners
Practice locations: Dyersburg, TN; Germantown, TN; Memphis, TN; Millington, TN
O20050531000282 MS Part B Supplier - Clinic/Group Practice 9830002583 Receives reassigned benefits from 10 practitioners
Practice locations: Horn Lake, MS; Olive Branch, MS; Oxford, MS; Southaven, MS
O20160728000133 AR Part B Supplier - Clinic/Group Practice 9830002583 Receives reassigned benefits from 10 practitioners
Practice locations: Jonesboro, AR; West Memphis, AR

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
44D2102003Charles Retina Institute1432 Kimbrough Rd, Germantown, TN 38138Certificate of waiverSep 14, 2027

National Provider Directory

National Provider Directory

Locations

6947 Crumpler Blvd
Ste 101
Olive Branch, MS 38654

1432 Kimbrough Rd
Germantown, TN 38138

930 Madison Ave
Ste 100
Memphis, TN 38103

6401 Poplar Ave
Ste 190
Memphis, TN 38119
Phone (901) 866-8700

6401 Poplar Ave
Ste 500
Memphis, TN 38119
Phone (901) 422-8191

2204 Crestmoor Rd
Nashville, TN 37215
Phone (615) 327-4015

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1477556306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1432 KIMBROUGH RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382405",
            "telephone_number": "901-767-4499",
            "fax_number": "901-761-0727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 KIMBROUGH RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382405",
            "telephone_number": "901-767-4499",
            "fax_number": "901-761-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES RETINA INSTITUTE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "MESSER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "901-767-4499"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD8675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3158650",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.