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Aegis Group Practice LLC

Organization Active NPI Physical Therapist · Boise, ID

NPI 1346949443 · NPPES record last updated Feb 27, 2023

Key facts

NPI
1346949443
Entity type
Organization (NPI type 2)
Primary specialty
Physical Therapist 225100000X
Legal business name
AEGIS GROUP PRACTICE LLC
Practice address
4890 N Cloverdale Rd
Boise, ID 83713-2401
Phone
(800) 444-6845
Fax
(479) 478-2852
NPI assigned
Feb 27, 2023
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 1

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) 1

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 400

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

View all 400

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ID

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20230717001935 ID Part B Supplier - Clinic/Group Practice 5193036432 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Boise, ID; Meridian, ID

National Provider Directory

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

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

4890 N Cloverdale Rd
Boise, ID 83713-2401

Mailing address

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

Other providers in Boise, ID

All providers in Boise, ID · Physical Therapist in Idaho

Sources for this page

Verify at the official NPI Registry.