Individual provider Active NPI

Ian Michael McNeill, PT, DPT, CERT DN

  • Physical Therapist
  • Watkinsville, GA
National Provider Identifier
1033885041
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015528 Issued in GA
Practice address
1260 Mars Hill Rd Ste 115
Watkinsville, GA 30677-4943
Phone
(706) 705-6110
NPI assigned
Aug 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT015528 GA Primary

Addresses

Primary practice location

1260 Mars Hill Rd Ste 115
Watkinsville, GA 30677-4943

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 497-0005

Other identifiers 1

IdentifierTypeStateIssuer
15380971OtherCAQH NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921002426 GA Practitioner - Physical Therapist in Private Practice 4587061361 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCM Rehabilitation LLCGroup PAC ID 5294798336, 58 clinicians

Practice addresses (Care Compare)

1260 Mars Hill Rd
Suite 115
Watkinsville, GA 30677-4943
Phone (706) 705-6110

5748 Old Winder Hwy
Suite 400 500
Braselton, GA 30517-1630
Phone (678) 866-4312

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT015528GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Agilitas USA, Inc Physical Therapist CurrentSince Dec 9, 2024 Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Dec 9, 2024 Accepting new patients
Independent Physical Therapy of Ga, LLC Physical Therapist CurrentSince Dec 9, 2024 Accepting new patients
Drayer Physical Therapy Georgia LLC Physical Therapist CurrentSince Dec 9, 2024 Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Dec 9, 2024 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Dec 9, 2024 Accepting new patients
Pediatric Orthopedic Associates Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660

3455 Highway 81
Loganville, GA 30052
Phone (678) 635-8280

1260 Mars Hill Rd
Ste 115
Watkinsville, GA 30677
Phone (706) 705-6110

6397 Lee Hwy
Ste 300
Chattanooga, TN 37421
Phone (423) 238-8923

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1033885041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-497-0005",
            "fax_number": "706-546-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MARS HILL RD STE 115",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774943",
            "telephone_number": "706-705-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNEILL",
        "first_name": "IAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PT, DPT, CERT DN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "15380971",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.

Verify at the official NPI Registry.