SOUTHEAST PART B PRACTICE
NPI 1295276970
Nurse Practitioner - Gerontology in Lake Village, AR
About Southeast Part B Practice NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHEAST PART B PRACTICE (NPI 1295276970) is a healthcare organization registered as a gerontology in Lake Village, Arkansas and active in the NPI registry since March 2017. The organization lists Cathy Waldrop, Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southeast Part B Practice is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Southeast Part B Practice, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently 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 Southeast Rehab LLC.'s NPI number?
The NPI number for Southeast Rehab LLC. is 1295276970. It was assigned to this organization in the NPPES registry on March 15, 2017. The provider is doing business as Southeast Part B Practice.
Where is Southeast Rehab LLC. located?
Southeast Rehab LLC. is located at 903 Borgognoni Dr, Lake Village, AR 71653. The listed phone number is (318) 665-9950.
What is Southeast Rehab LLC.'s specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Southeast Rehab LLC. enrolled in Medicare?
Yes. Southeast Rehab LLC. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southeast Rehab LLC.?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Southeast Rehab LLC.. 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 (3) and Family Practice (1). Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Southeast Rehab LLC. was last updated on June 28, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Southeast Part B Practice · NPI 1295276970
Gerontology organization in Lake Village, Arkansas. Organization record, active in the CMS NPPES registry since March 15, 2017.
## Identity
- **NPI:** 1295276970 (Entity type: Organization)
- **Enumerated:** March 15, 2017
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **Legal business name:** Southeast Rehab Llc.
- **Organization subpart:** No
- **Authorized official:** Cathy Waldrop, ADMINISTRATOR
## Practice location
- **Address:** 903 BORGOGNONI DR, Lake Village, AR 71653-1623
- **Phone:** (318) 665-9950
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (3), Family Practice (1); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 28, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1295276970) · Data from the CMS NPPES public registry.