Active NPI
Aegis Group Practice LLC
- Physical Therapist
- Fredericksburg, VA
National Provider Identifier
1841982287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 1301 Ashford Cir
Fredericksburg, VA 22401-5089 - Phone
- (800) 444-6845
- Fax
- (479) 478-2852
- NPI assigned
- May 24, 2023
- Last updated
- May 24, 2023
- 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
- Misty S Wilson
- Title
- Credentialing Specialist
- Phone
- (972) 372-6779
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
1301 Ashford Cir
Fredericksburg, VA 22401-5089
Mailing address
2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220603001114 | VA | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 10 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Virginia Beach, VA |
Other NPIs on the same Medicare enrollment 1
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": "1684886400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1684886400000",
"number": "1841982287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 NETWORK BLVD STE 102",
"city": "FRISCO",
"state": "TX",
"postal_code": "750349092",
"telephone_number": "972-372-6779",
"fax_number": "479-668-0872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 ASHFORD CIR",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224015089",
"telephone_number": "800-444-6845",
"fax_number": "479-478-2852"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS GROUP PRACTICE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-05-24",
"last_updated": "2023-05-24",
"certification_date": "2023-05-24",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "MISTY",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "972-372-6779"
},
"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 Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; 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.