Active NPI
Aegis Group Practice LLC
- Occupational Therapist
- Wildwood, MO
National Provider Identifier
1508368598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 251 Plaza Dr
Wildwood, MO 63040-1203 - Phone
- (800) 444-6845
- Fax
- (844) 640-6066
- NPI assigned
- Mar 6, 2018
- Last updated
- Mar 6, 2018
- 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) 201-2000
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | ||
| Occupational Therapist | 225X00000X | NU | Primary | |
| Speech-Language Pathologist | 235Z00000X | NU |
Addresses
Primary practice location
251 Plaza Dr
Wildwood, MO 63040-1203
Mailing address
1000 Fianna Way
Fort Smith, AR 72919-9008
Phone (479) 201-6089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161109000544 | MO | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 35 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: St Joseph, MO; Springfield, MO; Kirkwood, MO; Joplin, MO |
Other NPIs on the same Medicare enrollment 14
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": "1520294400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1520294400000",
"number": "1508368598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 FIANNA WAY",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729199008",
"telephone_number": "479-201-6089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 PLAZA DR",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630401203",
"telephone_number": "800-444-6845",
"fax_number": "844-640-6066"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-03-06",
"last_updated": "2018-03-06",
"status": "A",
"authorized_official_last_name": "MCOLVIN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "VP-FINANCE",
"authorized_official_telephone_number": "479-201-2000"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wildwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; 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.