NPIMap

Organization Active NPI

Retina Associates, PLLC

  • Retina Specialist (Ophthalmology) Physician
  • Raleigh, NC
National Provider Identifier
1760408397
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
RETINA ASSOCIATES, PLLC
Practice address
4414 Lake Boone TRL
Ste 302
Raleigh, NC 27607-7513
Phone
(919) 782-8038
Fax
(919) 782-8189
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Authorized official

Name
Daniel K Bennett, MDNPI 1376715565
Title
Owner
Phone
(919) 782-8038

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

4414 Lake Boone TRL
Ste 302
Raleigh, NC 27607-7513

Mailing address

4414 Lake Boone TRL Ste 302
Raleigh, NC 27607-7514
Phone (919) 782-8038

Other identifiers 4

IdentifierTypeStateIssuer
014T8OtherNCBCBS-GROUP
2333843OtherNCMEDICARE-GROUP
DB4007OtherNCRR MEDICARE-GROUP
89014T8MedicaidNC

Other names 1

  • North Carolina Retina Associates, PC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000484 NC Part B Supplier - Clinic/Group Practice 3870498876 Receives reassigned benefits from 21 practitioners
Practice locations: Cary, NC; Chapel Hill, NC; Clayton, NC; Durham, NC; Raleigh, NC; Wake Forest, NC

National Provider Directory

National Provider Directory

Locations

106 Ridge View Dr
Ste 100
Cary, NC 27511

77 Vilcom Center Dr
Ste 101
Chapel Hill, NC 27514

120 Conner Dr
Ste 100
Chapel Hill, NC 27514
Phone (919) 477-0047

220 Springbrook Ave
Ste 100
Clayton, NC 27520

220 Springbrook Ave
Clayton, NC 27520

5107 Southpark Dr
Ste 201
Durham, NC 27713
Phone (919) 782-8038

515 N Spence Ave
Goldsboro, NC 27534
Phone (919) 778-7110

2340 Hemby Ln
Ste 300
Greenville, NC 27834

2613 W Arlington Blvd
#102
Greenville, NC 27834

3124 Blue Ridge Rd
Raleigh, NC 27612
Phone (919) 782-0021

1101 Dresser Ct
Raleigh, NC 27609
Phone (919) 876-2010

4220 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-7810

2709 Blue Ridge Rd
Ste 170
Raleigh, NC 27607
Phone (919) 782-8038

5900 Six Forks Rd
Ste 105
Raleigh, NC 27609
Phone (919) 782-8038

4414 Lake Boone Trl
Ste 302
Raleigh, NC 27607
Phone (919) 782-8038

1408 Greenway Ct
Ste 100
Sanford, NC 27330

1212 Central Dr
Ste 102
Sanford, NC 27330

3113 Rogers Rd
Ste 200
Wake Forest, NC 27587

3150 Rogers Rd
Ste 200
Wake Forest, NC 27587

Interoperability endpoints

  • Direct secure messaging: ldesai@northcarolinaretina.intellechartdirect.net
  • Direct secure messaging: msubramanian@northcarolinaretina.intellechartdirect.net
  • Direct secure messaging: kscavelli@northcarolinaretina.intellechartdirect.net
  • Direct secure messaging: jprince@northcarolinaretina.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1760408397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL STE 302",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077514",
            "telephone_number": "919-782-8038",
            "fax_number": "919-782-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL",
            "address_2": "STE 302",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077513",
            "telephone_number": "919-782-8038",
            "fax_number": "919-782-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-782-8038",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-GROUP",
            "identifier": "014T8",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-GROUP",
            "identifier": "2333843",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE-GROUP",
            "identifier": "DB4007",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014T8",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Carolina Retina Associates, PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Carolina Retina Associates, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; 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.