Aegis Group Practice LLC
Organization Active NPI Physical Therapist · Elm Grove, WI
NPI 1003380205 · NPPES record last updated Nov 22, 2021
Key facts
- NPI
- 1003380205
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 800 Wall St
Elm Grove, WI 53122-2631 - Phone
- (800) 444-6845
- Fax
- (479) 478-2852
- NPI assigned
- Jan 22, 2019
- Organization subpart
- No
Authorized official
- Name
- Britt Jeffcoat
- Title
- Senior VP
- Phone
- (972) 372-6799
Other NPIs on the same Medicare enrollment 51
Corporate family (same tax ID) 12
Practitioners 3
-
Kyle Kirst, OTR
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170614002978 | WI | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 61 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wisconsin Rapids, WI; West Bend, WI; West Allis, WI; Port Washington, WI; Plymouth, WI; Oshkosh, WI; Hartland, WI; Onalaska, WI… |
| O20170720002185 | FL | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 17 practitioners 24 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Indian Harbour Beach, FL; Pensacola, FL |
National Provider Directory
- Tax ID family
- Aegis Group Practice
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
800 Wall St
Elm Grove, WI 53122-2631
Mailing address
4933 Old Greenwood Rd
Fort Smith, AR 72903-6906
Phone (479) 201-6147
Other providers in Elm Grove, WI
- Actualized Clinical Services Consulting, Inc.
- Ad Astra Therapy LLC
- Himanshu Agrawal
- Arlie J Albrecht
- Alive Chiropractic LLC
- Allergy Specialists
- American Behavioral Clinics
All providers in Elm Grove, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.