DR. FREDRIC PUCKETT, PLLC
NPI 1073748562
Family Medicine in Ennis, TX
About Dr. Fredric Puckett, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. FREDRIC PUCKETT, PLLC (NPI 1073748562) is a healthcare organization registered as a family medicine in Ennis, Texas and active in the NPI registry since May 2009. The organization holds a CLIA Microscopy certificate valid through May 5, 2027 and lists Fredric Clark Puckett, Physician/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Fredric Puckett, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 2027
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.
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Dr. Fredric Puckett, PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D2024029
Dr Fredric Puckett PLLC · Ennis, TXFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dr. Fredric Puckett, PLLC's NPI number?
The NPI number for Dr. Fredric Puckett, PLLC is 1073748562. It was assigned to this organization in the NPPES registry on May 27, 2009.
Where is Dr. Fredric Puckett, PLLC located?
Dr. Fredric Puckett, PLLC is located at 2203 W Lampasas St Ste 111, Ennis, TX 75119. The listed phone number is (972) 875-6200.
What is Dr. Fredric Puckett, PLLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Dr. Fredric Puckett, PLLC enrolled in Medicare?
Yes. Dr. Fredric Puckett, PLLC is registered in the Medicare PECOS enrollment system.
When is Dr. Fredric Puckett, PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Dr. Fredric Puckett, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Dr. Fredric Puckett, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4) and Family Practice (1). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Dr. Fredric Puckett, PLLC hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D2024029) is associated with this NPI, valid through May 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Dr. Fredric Puckett, PLLC was last updated on June 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Fredric Puckett, Pllc · NPI 1073748562
Family Medicine organization in Ennis, Texas. Organization record, active in the CMS NPPES registry since May 27, 2009.
## Identity
- **NPI:** 1073748562 (Entity type: Organization)
- **Enumerated:** May 27, 2009
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Fredric Puckett, PHYSICIAN/OWNER
## Practice location
- **Address:** 2203 W LAMPASAS ST STE 111, Ennis, TX 75119-5667
- **Phone:** (972) 875-6200 · **Fax:** (972) 875-6414
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Texas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 5 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Family Practice (1); 2 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 13, 2024
- **Other identifiers:** Medicaid 2080303202 (TX)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1073748562) · Data from the CMS NPPES public registry.