NPIMap

Organization Active NPI

Aegis Group Practice LLC

  • Physical Therapist
  • Tamarac, FL
National Provider Identifier
1609386234
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
AEGIS GROUP PRACTICE LLC
Practice address
6700 W Commercial Blvd
Tamarac, FL 33319-2115
Phone
(800) 444-6845
Fax
(844) 640-6066
NPI assigned
Oct 10, 2017
Last updated
Oct 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

6700 W Commercial Blvd
Tamarac, FL 33319-2115

Mailing address

1000 Fianna Way # Md5740
Fort Smith, AR 72919-9008
Phone (479) 201-6089

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170720002185 FL Part B Supplier - Clinic/Group Practice 5193036432 Receives reassigned benefits from 17 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indian Harbour Beach, FL; Pensacola, FL

Other NPIs on the same Medicare enrollment 24

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

View all 24

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1609386234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 FIANNA WAY # MD5740",
            "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": "6700 W COMMERCIAL BLVD",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333192115",
            "telephone_number": "800-444-6845",
            "fax_number": "844-640-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS GROUP PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tamarac, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; 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.