EAST SOUTHERN MEDICAL GROUP, LLC
NPI 1477011237
Physical Medicine & Rehabilitation in Mesa, AZ

Active since March 11, 2019
5233 E SOUTHERN AVE STE 103, MESA, AZ 85206(480) 830-2882(480) 830-2881 Get Directions Write a Review

NPPES record last updated: May 2, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 2, 2023, Jul 15, 2019, Mar 11, 2019 (3 updates tracked since 2019).

About East Southern Medical Group, Llc NPPES

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

EAST SOUTHERN MEDICAL GROUP, LLC (NPI 1477011237) is a healthcare organization registered as a physical medicine & rehabilitation in Mesa, Arizona and active in the NPI registry since March 2019. The organization lists Derek P Pruni, Owner, as its authorized official.

NPPES Registry Identity

NPI1477011237
Entity TypeOrganization
Primary Taxonomy208100000X
Legal Business NameEAST SOUTHERN MEDICAL GROUP, LLC
Location Address5233 E SOUTHERN AVE STE 103Mesa, AZ 85206-3628
Mailing Address5233 E Southern Ave Ste 103Mesa, AZ 85206-3628 · (480) 830-2882
Fax(480) 830-2881
Organization SubpartNo
Authorized OfficialDerek P PruniOwner · (480) 830-2882
Enumeration DateMarch 11, 2019
Last NPPES UpdateMay 2, 20233 updates tracked since enumeration
NPPES CertifiedMay 2, 2023
✔ NPI 1477011237 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical Medicine & RehabilitationAllopathic & Osteopathic Physicians
Taxonomy Code208100000X
Definition
Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
5233 E SOUTHERN AVE STE 103, Mesa, AZ 85206

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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)

East Southern Medical Group, Llc 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.

StateEnrollment IDDue date
StateArizonaEnrollment IDO20190912002914DME · Medical Supply CompanyDue dateJanuary 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to East Southern Medical Group, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Chiropractic
NPI 1598836264
5233 E SOUTHERN AVE SUITE 104
Mesa, AZ 85206
(480) 830-2882
✔ Accepts MedicareSame address
Chiropractic
NPI 1154304590
5233 E SOUTHERN AVE STE 104
Mesa, AZ 85206
(480) 785-4959
✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Medical Equipment Supplier Medicare DMEPOS 2

Medicare supplier enrollment and the product categories East Southern Medical Group LLC carries, from the Medicare DMEPOS supplier directory.

East Southern Medical Group LLC

DMEPOS supplier · Mesa, AZ
✔

Accepts Medicare assignment

East Southern Medical Group LLC agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20421065
Medicare Participant SinceJune 1, 2019
Supplier Location5233 E Southern Ave Ste 103Mesa, AZ 85206
Supplier Specialties
Medical Supply Company Other

Medicare Product Categories

Orthoses: Prefabricated (Non-Custom Fabricated)
Met pads, Heel pads, Heel spur pads
Orthoses: Off-The-Shelf
Met pads, Heel pads, Heel spur pads
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

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 East Southern Medical Group, LLC's NPI number?

The NPI number for East Southern Medical Group, LLC is 1477011237. It was assigned to this organization in the NPPES registry on March 11, 2019.

Where is East Southern Medical Group, LLC located?

East Southern Medical Group, LLC is located at 5233 E Southern Ave Ste 103, Mesa, AZ 85206. The listed phone number is (480) 830-2882.

What is East Southern Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation with taxonomy code 208100000X.

Is East Southern Medical Group, LLC enrolled in Medicare?

Yes. East Southern Medical Group, LLC is registered in the Medicare PECOS enrollment system.

When is East Southern Medical Group, LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (Arizona, Medical Supply Company) 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 East Southern Medical Group, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Chiropractic, reassign their Medicare billing to East Southern Medical Group, 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does East Southern Medical Group, LLC accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, East Southern Medical Group LLC accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

When was this NPI record last updated?

The NPPES record for East Southern Medical Group, LLC was last updated on May 2, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.