Background and aim Diabetic neuropathy is one of the most common long-term complications of diabetes. A frequent presentation of neuropathy is painful diabetic peripheral neuropathy (PDPN), which is associated with morbidity and disability among patients with diabetes. This study aims to estimate the prevalence of PDPN and its associated factors among patients with type 2 diabetes mellitus (T2DM) attending primary healthcare (PHC) in Al Ahsa. Methodology A cross-sectional study was conducted on patients with diabetes at National Guard PHC clinics in Al Ahsa, Saudi Arabia. An interview-administered questionnaire was used to collect information about clinicodemographic characteristics, and the Douleur Neuropathique-4 (DN4) questionnaire was used to identify the presence of PDPN.  Results A total of 342 patients with T2DM were included. The prevalence of PDPN was 29.8%. Patients' ages ranged from 25-70 years, with a mean age of 48.5 ± 12.3 years. The majority were female (118, 52.6%), with obesity detected among 115 (33.6%) individuals. Significant predictors of PDPN included noncompliance to treatment (odds ratio [OR] = 5.9, = 0.001), female gender (OR = 3.5, = 0.001), presence of other comorbidities (OR = 1.7, = 0.001), and diabetes duration exceeding 15 years (OR = 1.5, = 0.001). Conclusions This study revealed that PDPN was frequent among patients with diabetes in Al Ahsa, which was at an intermediate frequency relative to reported national and global literature levels. Identifying patients who are at high risk and implementing timely interventions are crucial.