Active NPI
Aegis Group Practice, LLC
- Occupational Therapist
- Hollywood, FL
National Provider Identifier
1740720002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Legal business name
- AEGIS GROUP PRACTICE, LLC
- Practice address
- 2580 Pine Island Rd
Hollywood, FL 33024-8582 - Phone
- (479) 201-2000
- Fax
- (479) 201-4801
- NPI assigned
- Mar 6, 2017
- Last updated
- Mar 6, 2017
- Organization subpart
- Yes
- Parent organization
- AEGIS THERAPIES, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mike McOlvin
- Title
- Director
- Phone
- (479) 201-2000
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Occupational Therapist | 225X00000X | Primary | ||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
2580 Pine Island Rd
Hollywood, FL 33024-8582
Mailing address
1000 Fianna Way # Md4843
Fort Smith, AR 72919-9008
Phone (479) 201-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
National Provider Directory
National Provider Directory- Part of
- Aegis
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488758400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488758400000",
"number": "1740720002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 FIANNA WAY # MD4843",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729199008",
"telephone_number": "479-201-2000",
"fax_number": "479-201-4801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2580 PINE ISLAND RD",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330248582",
"telephone_number": "479-201-2000",
"fax_number": "479-201-4801"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AEGIS THERAPIES, INC.",
"enumeration_date": "2017-03-06",
"last_updated": "2017-03-06",
"status": "A",
"authorized_official_last_name": "MCOLVIN",
"authorized_official_first_name": "MIKE",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "479-201-2000"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
},
{
"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 Hollywood, FL
- Advanced Medical Research Group, Inc.
- Advanced Prosthetics of America Inc (Hanger Clinic)
- Advanced Psychiatric Services Professional Association
- Sarah Aeder, RN
- Aegis Group Practice LLC
- Aesthetic Medical Academy USA Inc
- Afc Medical Devices LLC
- Mesfin Afework, MD
- Affiliated Pediatrics of South Florida LLC
- Affiliated Pediatrics Ofbroward
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.