Active NPI
Aegis Group Practice LLC
- Physical Therapist
- Blairsville, GA
National Provider Identifier
1194255653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 493 Wesley Mountain Dr
Blairsville, GA 30512-2885 - Phone
- (800) 444-6845
- Fax
- (479) 478-2852
- NPI assigned
- Jun 18, 2017
- Last updated
- Apr 19, 2022
- Organization subpart
- Yes
- Parent organization
- AEGIS THERAPIES, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael McOlvin
- Title
- Vice President
- Phone
- (479) 201-6100
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
493 Wesley Mountain Dr
Blairsville, GA 30512-2885
Mailing address
4933 Old Greenwood Rd
Fort Smith, AR 72919-6906
Phone (479) 201-6147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150916001644 | GA | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 34 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Canton, GA; Suwanee, GA |
Other NPIs on the same Medicare enrollment 37
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Aegis
Locations
1000 Fianna Way
#2761
Fort Smith, AR 72919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497744000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1650326400000",
"number": "1194255653",
"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": "729196906",
"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": "493 WESLEY MOUNTAIN DR",
"city": "BLAIRSVILLE",
"state": "GA",
"postal_code": "305122885",
"telephone_number": "800-444-6845",
"fax_number": "479-478-2852"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AEGIS THERAPIES, INC.",
"enumeration_date": "2017-06-18",
"last_updated": "2022-04-19",
"certification_date": "2022-04-19",
"status": "A",
"authorized_official_last_name": "MCOLVIN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "479-201-6100"
},
"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 Blairsville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.