NPIMap

Organization Active NPI

Specialty Retina Center LLC

  • Ophthalmology Physician
  • Deerfield Beach, FL
National Provider Identifier
1689807232
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME 81086 Issued in FL
Legal business name
SPECIALTY RETINA CENTER LLC
Practice address
2001 W Sample Rd Ste 320
Deerfield Beach, FL 33064-1342
Phone
(561) 322-3588
Fax
(754) 812-5993
NPI assigned
Aug 31, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Authorized official

Name
Shatina M Cannon
Title
Office Manager
Phone
(561) 322-3588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X ME 81086 FL Primary

Addresses

Primary practice location

2001 W Sample Rd Ste 320
Deerfield Beach, FL 33064-1342

Mailing address

2001 W Sample Rd Ste 320
Deerfield Beach, FL 33064-1342
Phone (561) 322-3588

Other practice location 1

21301 Powerline Rd Ste 105
Boca Raton, FL 33433-2389
Phone (561) 322-3588

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091031000020 FL Part B Supplier - Clinic/Group Practice 5294872891 Receives reassigned benefits from 11 practitioners
Practice locations: Boca Raton, FL; Pompano Beach, FL; Delray Beach, FL; Deerfield Beach, FL

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
10D2107599Specialty Retina Center2001 W Sample Rd Ste 320 & 322, Deerfield Beach, FL 33064Certificate of waiverJan 18, 2028

National Provider Directory

National Provider Directory

Locations

2001 W Sample Rd
Ste 320
Deerfield Beach, FL 33064
Phone (561) 322-3588

Networks

  • HealthSun Health Plans Network

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/doctorsoft_specialtyretinacenter

Practitioners & affiliated clinicians

Practitioners 11

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": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738713600000",
    "number": "1689807232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 W SAMPLE RD STE 320",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "330641342",
            "telephone_number": "561-322-3588",
            "fax_number": "754-812-5993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W SAMPLE RD STE 320",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "330641342",
            "telephone_number": "561-322-3588",
            "fax_number": "754-812-5993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21301 Powerline Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334332389",
            "country_code": "US",
            "telephone_number": "561-322-3588",
            "fax_number": "754-812-5993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECIALTY RETINA CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "SHATINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "561-322-3588"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME 81086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.