NPIMap

Organization Active NPI

Southeast Orthopedic Specialists, LLC

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1629025820
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Practice address
14534 Old Saint Augustine Rd Ste 3210
Jacksonville, FL 32258-2645
Phone
(904) 675-4000
Fax
(904) 675-4007
NPI assigned
May 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brett Puckett, MDNPI 1831150960
Title
Authorized Official
Phone
(904) 634-0640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X
Adult Reconstructive Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0114X
Orthopaedic Foot and Ankle Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0004X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X
Orthopaedic Trauma PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0801X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X

Addresses

Primary practice location

14534 Old Saint Augustine Rd Ste 3210
Jacksonville, FL 32258-2645

Mailing address

PO Box 14009
Belfast, ME 04915-4031
Phone (904) 396-1725

Other practice location 1

5191 First Coast Tech Pkwy Fl 3
Jacksonville, FL 32224-0609
Phone (904) 675-4000

Other identifiers 12

IdentifierTypeStateIssuer
107540813MedicaidFL
107540814MedicaidFL
107540819MedicaidFL
107540818MedicaidFL
107540800MedicaidFL
107540805MedicaidFL
107540807MedicaidFL
107540810MedicaidFL
107540817MedicaidFL
107540816MedicaidFL
107540808MedicaidFL
107540811MedicaidFL

Other names 1

  • R David Heekin, MD, PA Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040216000301 FL Part B Supplier - Clinic/Group Practice 1456246974 Receives reassigned benefits from 191 practitioners
Practice locations: St Augustine, FL; St Johns, FL; Ponte Vedra Beach, FL; Orange Park, FL; Jacksonville, FL
O20190702003183 GA Part B Supplier - Clinic/Group Practice 1456246974 Receives reassigned benefits from 2 practitioners
Practice locations: Waycross, GA

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4565 US Highway 17
Fleming Island, FL 32003

10475 Centurion Pkwy N
Ste 102
Jacksonville, FL 32256

4268 Oldfield Crossing Dr
Ste 201
Jacksonville, FL 32223
Phone (904) 630-0640

15255 Max Leggett Pkwy
Ste 5300
Jacksonville, FL 32218
Phone (904) 203-1386

2627 Riverside Ave
#3
Jacksonville, FL 32204

6500 Bowden Rd
Ste 103
Jacksonville, FL 32216

10475 Centurion Pkwy N
Ste 305
Jacksonville, FL 32256

10475 Centurion Pkwy N
Ste 200
Jacksonville, FL 32256

2300 Park Ave
Ste 203
Orange Park, FL 32073
Phone (904) 278-0016

232 Ponte Vedra Park Dr
#300
Ponte Vedra Beach, FL 32082

216 Southpark Cir E
#216
St Augustine, FL 32086

45 Groover Loop
St Augustine, FL 32086
Phone (904) 648-8660

216 Southpark Cir E
Ste 216
St Augustine, FL 32086
Phone (904) 634-0203

216 Southpark Cir E
St Augustine, FL 32086
Phone (904) 824-6108

Practitioners & affiliated clinicians

Practitioners 225

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 225

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1629025820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14009",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154031",
            "telephone_number": "904-396-1725",
            "fax_number": "904-396-4893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14534 OLD SAINT AUGUSTINE RD STE 3210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582645",
            "telephone_number": "904-675-4000",
            "fax_number": "904-675-4007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5191 First Coast Tech Pkwy Fl 3",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322240609",
            "country_code": "US",
            "telephone_number": "904-675-4000",
            "fax_number": "904-672-4007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-634-0640",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540813",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540814",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540819",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540818",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540805",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540807",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540810",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540817",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540816",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540808",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107540811",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "R David Heekin, MD, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.