SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
NPI 1003542465
Durable Medical Equipment & Medical Supplies in St Johns, FL

Q: What is Southeast Orthopedic Specialists, LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Active since July 28, 2022

3055 COUNTY ROAD 210 W STE 110, ST JOHNS, FL 32259(904) 634-0640(904) 634-0203 Get Directions Write a Review

NPPES record last updated: March 8, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 8, 2023, Jul 28, 2022 (2 updates tracked since 2022).

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About Southeast Orthopedic Specialists, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC (NPI 1003542465) is a healthcare organization registered as a durable medical equipment & medical supplies in St Johns, Florida and active in the NPI registry since July 2022. The organization lists Brett Puckett, Md, as its authorized official.

NPPES Registry Identity

NPI1003542465

Entity TypeOrganization

Primary Taxonomy332B00000X

Legal Business NameSOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

Location Address3055 COUNTY ROAD 210 W STE 110St Johns, FL 32259-7001

Mailing Address6800 Southpoint Pkwy Ste 300Jacksonville, FL 32216-8203 · (904) 634-0640 · Fax (904) 634-0203

Phone(904) 634-0640

Fax(904) 634-0203

Organization SubpartNo

Authorized OfficialBrett PuckettMd · (904) 634-0640

Enumeration DateJuly 28, 2022

Last NPPES UpdateMarch 8, 20232 updates tracked since enumeration

NPPES CertifiedMarch 8, 2023

✔ NPI 1003542465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers

Taxonomy Code332B00000X

Definition

A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

Also ListedDurable Medical Equipment & Medical Supplies · Customized EquipmentTaxonomy 332BC3200X

Also ListedProsthetic/Orthotic SupplierTaxonomy 335E00000X

3055 COUNTY ROAD 210 W STE 110, St Johns, FL 32259

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Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southeast Orthopedic Specialists, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateFloridaEnrollment IDO20221004001972DME · Physician - Orthopedic/Orthopedic SurgeryDue dateDecember 31, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAYLA JEANNE STADIUS PT, DPT, EP-C

Physical Therapist