NPIMap

Organization Active NPI

Mid-South Retina Associates, LLC

  • Ophthalmology Physician
  • Jonesboro, AR
National Provider Identifier
1861428534
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MID-SOUTH RETINA ASSOCIATES, LLC
Practice address
820 E Matthews Ave
Suite E
Jonesboro, AR 72401-3048
Phone
(870) 933-9262
Fax
(901) 682-6915
NPI assigned
Jun 24, 2006
Organization subpart
Yes
Parent organization
MID-SOUTH RETINA ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2024

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
(870) 933-9262

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

820 E Matthews Ave
Suite E
Jonesboro, AR 72401-3048

Mailing address

PO Box 1000 Dept 448
Memphis, TN 38148-0448
Phone (870) 933-9262

Other identifiers 2

IdentifierTypeStateIssuer
5C535OtherARARKANSAS MEDICARE
107479001MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Mid-South Retina Associates LLC8 organizations share this tax ID, including this one
Part of
Mid-South Retina Associates LLC

Other organizations with this tax ID 7

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

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 2

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1861428534",
    "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": "870-933-9262",
            "fax_number": "901-682-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E MATTHEWS AVE",
            "address_2": "SUITE E",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013048",
            "telephone_number": "870-933-9262",
            "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": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "SIEVERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "870-933-9262",
        "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": "ARKANSAS MEDICARE",
            "identifier": "5C535",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107479001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.