East Southern Medical Group, LLC
NPI 1477011237ActiveOrganization· Physical Medicine & Rehabilitation· Mesa, AZ
Physical Medicine & Rehabilitation in Mesa, Arizona, registered in NPPES in March 2019. The authorized official on file is Derek P. Pruni, DC, Owner. Enrolled in Medicare as dme supplier - medical supply company and part b supplier - clinic/group practice.
Overview
| NPI | 1477011237 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 11, 2019 |
| Last updated in NPPES | May 2, 2023 |
| Certified by provider | May 2, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Medicine & Rehabilitation Primary | 208100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Medical Supply Company (AZ); Part B Supplier - Clinic/Group Practice (AZ) |
|---|
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