NPIMap

Organization Active NPI

Southeastern Retina Associates, P.C.

  • Retina Specialist (Ophthalmology) Physician
  • Kingsport, TN
National Provider Identifier
1932370145
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
SOUTHEASTERN RETINA ASSOCIATES, P.C.
Practice address
2412 N John B Dennis Hwy
Kingsport, TN 37660-4772
Phone
(423) 578-4364
Fax
(423) 578-4372
NPI assigned
Mar 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Authorized official

Name
Mr. Andrew Laverghetta
Title
Ceo
Phone
(865) 588-0811

Specialties & licenses 2

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

Addresses

Primary practice location

2412 N John B Dennis Hwy
Kingsport, TN 37660-4772

Mailing address

9050 Executive Park Dr Ste 202a
Knoxville, TN 37923-4670

Other identifiers 4

IdentifierTypeStateIssuer
3715424MedicaidTN
CD7808OtherTNRAILROAD MEDICARE
89011K5MedicaidNC
CG2897OtherVARAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000507 TN Part B Supplier - Clinic/Group Practice 7517862360 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Knoxville, TN; Sevierville, TN; Powell, TN; Oak Ridge, TN; Morristown, TN; Maryville, TN; Kingston, TN; Kingsport, TN…
O20040602001360 VA Part B Supplier - Clinic/Group Practice 7517862360 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Abingdon, VA; Bristol, VA

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

Locations

2412 N John B Dennis Hwy
Kingsport, TN 37660
Phone (423) 378-4402

2236 E Stone Dr
Kingsport, TN 37660
Phone (423) 578-4368

Knoxville, TN 37995

9050 Executive Park Dr
Ste 202A
Knoxville, TN 37923

160 Cummings St
Abingdon, VA 24210

Interoperability endpoints

  • Direct secure messaging: jcox@seretina.intellechartdirect.net
  • Direct secure messaging: cbaer@seretina.intellechartdirect.net
  • Direct secure messaging: ahaider@seretina.intellechartdirect.net
  • Direct secure messaging: jfuerst@seretina.intellechartdirect.net
  • Direct secure messaging: mmagee@seretina.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": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1932370145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9050 EXECUTIVE PARK DR STE 202A",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 N JOHN B DENNIS HWY",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604772",
            "telephone_number": "423-578-4364",
            "fax_number": "423-578-4372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RETINA ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "LAVERGHETTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "865-588-0811",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3715424",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD7808",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011K5",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CG2897",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.