NPIMap

Organization Active NPI

Aegis Group Practice LLC

  • Physical Therapist
  • Lisle, IL
National Provider Identifier
1275259798
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 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
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 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

Medicare participation

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

Enrollment records 1

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

Other NPIs with the same Medicare PAC ID 23

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

View all 23

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Marguerite Thompson PT216 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

502 W Pine St
Farmington, MO 63640
Phone (573) 218-9991

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1665964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1275259798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 NETWORK BLVD STE 102",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750349092",
            "telephone_number": "972-372-6779",
            "fax_number": "479-668-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 MAPLE AVE",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605322179",
            "telephone_number": "800-444-6845",
            "fax_number": "479-478-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS GROUP PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CONTRACT/CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "972-372-6779"
    },
    "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 Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.

Verify at the official NPI Registry.