NPIMap

Organization Active NPI

Mid-South Retina Associates, LLC

  • Ophthalmology Physician
  • Dyersburg, TN
National Provider Identifier
1689600215
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MID-SOUTH RETINA ASSOCIATES, LLC
Practice address
401 E Tickle St
Dyersburg, TN 38024-3163
Phone
(731) 286-1240
Fax
(901) 682-6915
NPI assigned
Jun 24, 2006
Last updated
Jan 28, 2008By 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 Jan 28, 2008

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

401 E Tickle St
Dyersburg, TN 38024-3163

Mailing address

PO Box 1000 Dept 448
Memphis, TN 38148-0448
Phone (731) 286-1240

Other identifiers 2

IdentifierTypeStateIssuer
3066300OtherTNBLUE CROSS OF TENNESSEE
3050718MedicaidTN

National Provider Directory

National Provider Directory
Tax ID family
Mid-South Retina Associat8 organizations share this tax ID, including this one
Part of
Mid-South Retina Associat

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1201478400000",
    "number": "1689600215",
    "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": "731-286-1240",
            "fax_number": "901-682-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E TICKLE ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243163",
            "telephone_number": "731-286-1240",
            "fax_number": "901-682-6915"
        }
    ],
    "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": "2008-01-28",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TENNESSEE",
            "identifier": "3066300",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3050718",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersburg, TN

Sources for this page

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