NPIMap

Aegis Group Practice LLC

Organization Active NPI Physical Therapist · Lisle, IL

NPI 1275259798 · NPPES record last updated Oct 17, 2022

Key facts

NPI
1275259798
Entity type
Organization (NPI type 2)
Primary specialty
Physical Therapist 225100000X
Legal business name
AEGIS GROUP PRACTICE LLC
Practice address
1920 Maple Ave
Lisle, IL 60532-2179
Phone
(800) 444-6845
Fax
(479) 478-2852
NPI assigned
Oct 17, 2022
Organization subpart
No

Authorized official

Name
Misty S Wilson
Title
Contract/Credentialing Specialist
Phone
(972) 372-6779

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 411

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 411

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20221130001868 IL Part B Supplier - Clinic/Group Practice 5193036432 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
Practice locations: Carmi, IL; Lisle, IL; Rockford, IL

National Provider Directory

Tax ID family
Aegis Group Practice (204 organizations share this tax ID)

Locations

1112 Oak St
Carmi, IL 62821
Phone (217) 732-9651

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225100000X Yes
Occupational Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225X00000X
Speech-Language Pathologist
Group: 193200000X MULTI-SPECIALTY GROUP		 235Z00000X

Addresses

Primary practice location

1920 Maple Ave
Lisle, IL 60532-2179

Mailing address

2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779

Other providers in Lisle, IL

All providers in Lisle, IL · Physical Therapist in Illinois

Sources for this page

Verify at the official NPI Registry.