Southern Retinal Institute, LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

202072 Issued in LA

Legal business name

SOUTHERN RETINAL INSTITUTE, LLC

Practice address

2800 Veterans Memorial Blvd Ste 160
Metairie, LA 70002-6175

Phone

(504) 264-9428

Fax

(504) 264-9438

NPI assigned

Oct 26, 2017

Last updated

Jan 31, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Rhonda Garrison, CREDENTIALING

Title

Credentialing Coordinator

Phone

(865) 584-2127

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Tax ID family

Southern Retinal Institute LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Southern Retinal Institute, LLC

  • Ophthalmology Physician
  • Metairie, LA
  • NPI 1295240596
  NPD tax ID

Practitioners 2

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.

• Patrick Sean O'Sullivan, MD

  • Ophthalmology Physician
  • Metairie, LA
  • NPI 1265642482
  Medicare reassignment NPD
• Ethan Mitchel Stern, MD

  • Ophthalmology Physician
  • Jackson, MI
  • NPI 1710470281

  LA

  Medicare reassignment NPD

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1912419227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 VETERANS MEMORIAL BLVD STE 160",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700026175",
            "telephone_number": "504-264-9472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 VETERANS MEMORIAL BLVD STE 160",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700026175",
            "telephone_number": "504-264-9428",
            "fax_number": "504-264-9438"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1421 Ochsner Blvd",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "LA",
            "postal_code": "704338110",
            "country_code": "US",
            "telephone_number": "985-590-5339",
            "fax_number": "985-601-2958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN RETINAL INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-26",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "865-584-2127",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CREDENTIALING"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "LA",
            "license": "202072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1162353",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Metairie, LA
• Providers in Metairie, LA by specialty
• Ophthalmology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; 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.