NPIMap

Organization Active NPI

Southeast Orthopedic Specialists, LLC

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1629025820
Registry record updated Oct 7, 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
2627 Riverside Ave Ste 300
Jacksonville, FL 32204-4717
Phone
(904) 634-0640
Fax
(904) 675-4007
NPI assigned
May 31, 2006
Last updated
Oct 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 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

2627 Riverside Ave Ste 300
Jacksonville, FL 32204-4717

Mailing address

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

Other practice location 1

4565 US Highway 17 Ste 200
Fleming Island, FL 32003-4823
Phone (904) 634-0640

Other practice location 2

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082-6600
Phone (904) 634-0640

Other practice location 3

4268 Oldfield Crossing Dr Ste 201
Jacksonville, FL 32223-8800
Phone (904) 634-0640

Other practice location 4

2300 Park Ave Ste 206
Orange Park, FL 32073-5573
Phone (904) 634-0640

Other practice location 5

10475 Centurion Pkwy N Ste 301
Jacksonville, FL 32256-5004
Phone (904) 634-0640

Other practice location 6

15255 Max Legget Pkwy Ste 5300
Jacksonville, FL 32218-7274
Phone (904) 634-0640

Other practice location 7

1690 US Highway 1 S Ste F
St Augustine, FL 32084-6024
Phone (904) 634-0640

Other practice location 8

6800 Southpoint Pkwy Ste 300
Jacksonville, FL 32216-8203
Phone (904) 634-0640

Other practice location 9

2110 Herschel St
Jacksonville, FL 32204-3820
Phone (904) 634-0640

Other practice location 10

3055 County Road 210 W Ste 110
St Johns, FL 32259-7001
Phone (904) 634-0203

Other practice location 11

2 Shircliff Way Ste 605
Jacksonville, FL 32204-4762
Phone (904) 634-0640

Other practice location 12

10475 Centurion Pkwy N Ste 305
Jacksonville, FL 32256-5004
Phone (904) 634-0640

Other practice location 13

10475 Centurion Pkwy N Ste 102
Jacksonville, FL 32256-5004
Phone (904) 634-0640

Other practice location 14

10475 Centurion Pkwy N Ste 220
Jacksonville, FL 32256-5004
Phone (904) 634-0640

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

4565 US Highway 17
Ste 200
Fleming Island, FL 32003
Phone (904) 630-0640

10475 Centurion Pkwy N
Ste 200
Jacksonville, FL 32256

10475 Centurion Pkwy N
Ste 220
Jacksonville, FL 32256
Phone 9046340640 ext. 1014

2627 Riverside Ave
#3
Jacksonville, FL 32204

3530 Kraft Rd
Ste 201
Naples, FL 34105
Phone (239) 445-2112

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

236 Ponte Vedra Park Dr
Ste 300
Ponte Vedra Beach, FL 32082
Phone (904) 280-3440

1690 US Highway 1 S
Ste F
Saint Augustine, FL 32084
Phone (904) 634-0460

216 Southpark Cir E
#216
St Augustine, FL 32086

216 Southpark Cir E
Ste 216
St Augustine, FL 32086
Phone (904) 634-0460

45 Groover Loop
St Augustine, FL 32086
Phone (903) 634-0640

300 Saint Elizabeth Way
Ste 210
St Johns, FL 32259
Phone (904) 691-9200

Practitioners & affiliated clinicians

Practitioners 225

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1791331200000",
    "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": "2627 RIVERSIDE AVE STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044717",
            "telephone_number": "904-634-0640",
            "fax_number": "904-675-4007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4565 US Highway 17 Ste 200",
            "address_purpose": "LOCATION",
            "city": "Fleming Island",
            "state": "FL",
            "postal_code": "320034823",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "232 Ponte Vedra Park Dr",
            "address_purpose": "LOCATION",
            "city": "Ponte Vedra Beach",
            "state": "FL",
            "postal_code": "320826600",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4268 Oldfield Crossing Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322238800",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2300 Park Ave Ste 206",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320735573",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10475 Centurion Pkwy N Ste 301",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322565004",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15255 Max Legget Pkwy Ste 5300",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322187274",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1690 US Highway 1 S Ste F",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320846024",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6800 Southpoint Pkwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322168203",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2110 Herschel St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322043820",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3055 County Road 210 W Ste 110",
            "address_purpose": "LOCATION",
            "city": "St Johns",
            "state": "FL",
            "postal_code": "322597001",
            "country_code": "US",
            "telephone_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Shircliff Way Ste 605",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044762",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10475 Centurion Pkwy N Ste 305",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322565004",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10475 Centurion Pkwy N Ste 102",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322565004",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10475 Centurion Pkwy N Ste 220",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322565004",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "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": [],
    "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 Oct 7, 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.