SOUTHEASTERN RETINA ASSOCIATES, P.C. – Retina Specialist (Ophthalmology) Physician, NPI 1104097310
Retina Specialist (Ophthalmology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTHEASTERN RETINA ASSOCIATES, P.C.
9050 EXECUTIVE PARK DR STE 202A
KNOXVILLE, TN 379234670
Phone: (865) 588-0811
Fax: (865) 934-3892
Type: Mailing
1961 NORTHPOINT BLVD STE 110
HIXSON, TN 373434556
Phone: (423) 756-1002
Type: Location
1605 WILLIAMS RD STE 201
HIXSON, TN 373434934
Phone: (423) 756-1002
Fax: (423) 756-1004
Type: Location
320, Prosperity Drive, Knoxville, Knox County, Tennessee, 37923, United States
KNOXVILLE, TN 379234709
Phone: (423) 756-1512
Fax: (423) 756-1004
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-05-28
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-11-30 (197 days ago).
Enrollment records
2
Earliest due date
2025-11-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031204000507 | O | Clinic/Group Practice | TN | 2025-12-31 |
| O20040528000049 | O | Clinic/Group Practice | GA | 2025-11-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 37923)
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