Active NPI
Aegis Group Practice LLC
- Occupational Therapist
- Macon, GA
National Provider Identifier
1235648957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 300 Charter Blvd
Macon, GA 31210-4875 - Phone
- (800) 444-6845
- NPI assigned
- Sep 26, 2017
- Last updated
- Apr 19, 2022
- 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
- Michael McOlvin
- Title
- VP-Finance
- Phone
- (479) 201-6000
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Occupational Therapist | 225X00000X | Primary | ||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
300 Charter Blvd
Macon, GA 31210-4875
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 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 DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506384000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1650326400000",
"number": "1235648957",
"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": "300 CHARTER BLVD",
"city": "MACON",
"state": "GA",
"postal_code": "312104875",
"telephone_number": "800-444-6845"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-09-26",
"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": "VP-FINANCE",
"authorized_official_telephone_number": "479-201-6000"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
- Advance Wellness First
- Advanced Dental Arts, LLC
- Advanced Home Care, Inc
- Advanced Juvenile Enhancement, LLC
- Advocacy Resource Center, Inc - Macon (Arc - Macon)
- Aegis Therapies Group Practice LLC
- Affinity Care Solutions LLC
- Affordable Dentures & Implants - Macon, P.C.
- Noleen C Afolabi-Brown, CRNA
- Oladiran Ademola Afolabi-Brown, M.D.
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.