NPIMap

Organization Active NPI

Aegis Group Practice LLC

  • Physical Therapist
  • Elm Grove, WI
National Provider Identifier
1003380205
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 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
Last updated
Nov 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Authorized official

Name
Britt Jeffcoat
Title
Senior VP
Phone
(972) 372-6799

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 51

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 51

National Provider Directory

National Provider Directory
Tax ID family
Marguerite Thompson PT216 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1003380205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4933 OLD GREENWOOD RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729036906",
            "telephone_number": "479-201-6147",
            "fax_number": "479-401-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WALL ST",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222631",
            "telephone_number": "800-444-6845",
            "fax_number": "479-478-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS GROUP PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "JEFFCOAT",
        "authorized_official_first_name": "BRITT",
        "authorized_official_title_or_position": "SENIOR VP",
        "authorized_official_telephone_number": "972-372-6799"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elm Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.