NPIMap

Organization Active NPI

Southeast Eye Specialists, PLLC

  • Ophthalmology Physician
  • Soddy Daisy, TN
National Provider Identifier
1750981189
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SOUTHEAST EYE SPECIALISTS, PLLC
Practice address
9453 Dayton Pike
Soddy Daisy, TN 37379-4751
Phone
(423) 508-7337
Fax
(423) 508-7338
NPI assigned
Oct 26, 2020
Last updated
Oct 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST EYE SPECIALISTS, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Authorized official

Name
Mrs. Stacey Michelle Crudup
Title
Chief Compliance Officer
Phone
(615) 234-0450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

9453 Dayton Pike
Soddy Daisy, TN 37379-4751

Mailing address

341 Cool Springs Blvd Ste 400
Franklin, TN 37067-7224
Phone (615) 349-8965

Other identifiers 3

IdentifierTypeStateIssuer
GRP6156OtherMEDICARE PIN
524169578AMedicaidGA
3721447OtherMEDICARE PIN

Other names 1

  • SouthEast Eye Specialists - Soddy Daisy Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000021 TN Part B Supplier - Clinic/Group Practice 6800708504 Receives reassigned benefits from 41 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McMinnville, TN; Morristown, TN; Mount Juliet, TN; Murfreesboro, TN; Nashville, TN; Newport, TN; Pulaski, TN; Sevierville, TN…

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Southeast Eye Spec PLLC

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

7268 Jarnigan Rd
Ste 200
Chattanooga, TN 37421
Phone 4235087337289

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 47

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.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1603670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1750981189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 COOL SPRINGS BLVD STE 400",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677224",
            "telephone_number": "615-349-8965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9453 DAYTON PIKE",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373794751",
            "telephone_number": "423-508-7337",
            "fax_number": "423-508-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST EYE SPECIALISTS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST EYE SPECIALISTS, PLLC",
        "enumeration_date": "2020-10-26",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "CRUDUP",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "615-234-0450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "GRP6156",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "524169578A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "3721447",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthEast Eye Specialists - Soddy Daisy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Soddy Daisy, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.