Active NPI
Premere Rehab, LLC
Doing business as Aegis on Madison
- Physical Therapist
- Seattle, WA
National Provider Identifier
1013332576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- PREMERE REHAB, LLC
- Doing business as
- Aegis on Madison
- Practice address
- 2200 E Madison St
Seattle, WA 98112-5337 - Phone
- (206) 203-6348
- NPI assigned
- Feb 20, 2014
- Last updated
- Feb 20, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laura Cantrell, PT
- Title
- Director of Rehab
- Phone
- (360) 901-8111
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
2200 E Madison St
Seattle, WA 98112-5337
Mailing address
25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697
Phone (503) 570-3665
Other names 1
- Aegis on Madison
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, UT
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110526000548 | WA | Part B Supplier - Clinic/Group Practice | 2567434764 |
Receives reassigned benefits from 13 practitioners 25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cheney, WA; Yakima, WA; Tacoma, WA; Silverdale, WA; Seattle, WA; Puyallup, WA; Camas, WA; Bothell, WA… |
| O20111130000600 | UT | Part B Supplier - Clinic/Group Practice | 2567434764 |
Receives reassigned benefits from 1 practitioner 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Washington, UT |
Other NPIs on the same Medicare enrollment 31
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Prestige Senior Living Bridgewood
- Physical Therapist
- Vancouver, WA
- NPI 1588063242
O20110526000548
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2086261 | Aegis of Madison | Certificate of waiver | Apr 4, 2028 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
-
- Geriatric Physical Therapist
- Tualatin, OR
- NPI 1588855126
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392854400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1392854400000",
"number": "1013332576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25117 SW PARKWAY AVE STE D",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709697",
"telephone_number": "503-570-3665",
"fax_number": "877-282-1880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 E MADISON ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981125337",
"telephone_number": "206-203-6348"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMERE REHAB, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-02-20",
"last_updated": "2014-02-20",
"status": "A",
"authorized_official_last_name": "CANTRELL",
"authorized_official_first_name": "LAURA",
"authorized_official_title_or_position": "DIRECTOR OF REHAB",
"authorized_official_telephone_number": "360-901-8111",
"authorized_official_credential": "PT"
},
"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": [
{
"organization_name": "Aegis on Madison",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Seattle, WA
- Preferred Orthotic and Prosthetic Services Inc (Evergreen Prosthetics and Orthotics)
- Pedro Jose Prellwitz Lima, M.D
- Shruti Prem, M.D.
- Premere Rehab LLC (Infinity Rehab)
- Premere Rehab LLC (Infinity Rehab)
- Premier Behavioral Health Associates, PLLC
- Premier Chiropractic 5 PLLC
- Premier Chiropractic No. 9 PLLC
- Premier Nursing Care Agency
- Premier Nursing Care Agency LLC. (Premier Home Healthcare Agency LLC.)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.