Active NPI
Aegis Group Practice, LLC
- Physical Therapist
- Roswell, GA
National Provider Identifier
1841705985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- AEGIS GROUP PRACTICE, LLC
- Practice address
- 4401 Shallowford Rd Ste 158
Roswell, GA 30075-3175 - Phone
- (800) 444-6845
- Fax
- (844) 640-6066
- NPI assigned
- Dec 12, 2017
- Last updated
- Dec 12, 2017
- 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 | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
4401 Shallowford Rd Ste 158
Roswell, GA 30075-3175
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 GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150916001644 | GA | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 34 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Canton, GA; Suwanee, GA |
Other NPIs on the same Medicare enrollment 37
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
1000 Fianna Way
#5740
Fort Smith, AR 72919
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Physical Therapist
- Roswell, GA
- NPI 1801965074
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513036800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1513036800000",
"number": "1841705985",
"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": "4401 SHALLOWFORD RD STE 158",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300753175",
"telephone_number": "800-444-6845",
"fax_number": "844-640-6066"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-12-12",
"last_updated": "2017-12-12",
"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 Roswell, GA
- Advanced Urology Institute of Georgia (Advanced Urology)
- Advantage Bodycare Solutions, LLC
- Adventures in Balance, LLC
- Aegis Group Practice LLC
- Aegis Group Practice LLC
- Aeon Hospice LLC
- Aesthetic Specialty Centre, PC (Aesthetic Specialty Centre)
- Afc Physicians of Georgia, PC
- Affordable Mental Health, LLC
- Afw Healthcare Inc (Advanced Family Wellness)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.