NPIMap

Organization Active NPI

Aegis Homecare, Inc

Doing business as Aegis Homecare

  • Home Health Agency
  • Mesa, AZ
National Provider Identifier
1902179302
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
AEGIS HOMECARE, INC
Doing business as
Aegis Homecare
Practice address
7227 E Baseline Rd Ste 127
Mesa, AZ 85209-5006
Phone
(480) 219-4790
Fax
(480) 584-5871
NPI assigned
Feb 15, 2012
Last updated
Dec 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Benjamin Larsen
Title
Administrator
Phone
(435) 754-4962

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X AZ Primary

Addresses

Primary practice location

7227 E Baseline Rd Ste 127
Mesa, AZ 85209-5006

Mailing address

7227 E Baseline Rd Ste 127
Mesa, AZ 85209-5006
Phone (480) 219-4790

Other identifiers 3

IdentifierTypeStateIssuer
HHA5406OtherAZARIZONA STATE LICENSE
746297MedicaidAZ
03D2038146OtherAZCLIA WAIVER

Other names 1

  • Aegis Homecare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120601000271 AZ Part A Provider - Home Health Agency 5092978080 Practice locations: Mesa, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902179302. Details of each certification follow.

Home health agency certification: CCN 037422

Legal name
AEGIS HOMECARE, INC
Doing business as
AEGIS HOMECARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 6, 2013
Last certification
Feb 6, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Feb 14, 2012 in UT
Enrollment address
7227 E Baseline Rd
Ste 127
Mesa, AZ 85209-5006

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aegis Homecare, IncCCN 037422 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Feb 6, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2038146Aegis Homecare, Inc7227 E Baseline Rd #127, Mesa, AZ 85209Certificate of waiverMar 12, 2028

National Provider Directory

National Provider Directory

Locations

303 N Centennial Way
Ste 200
Mesa, AZ 85201
Phone (480) 527-0337

7227 E Baseline Rd
Ste 127
Mesa, AZ 85209
Phone (480) 219-4790

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Margene Farnsworth Burk Individual W-2 Managing EmployeeDirector of Nursing Feb 1, 2024
Bradley Butcher Individual W-2 Managing EmployeeDirector of Operations Feb 1, 2024
Benjamin Larsen Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 37.5%
Corporate Officer Sep 1, 2025 37.5%
Corporate Director Sep 1, 2025 37.5%
Tyler Franklin Pace Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 25%
General Partnership Interest Sep 1, 2025 25%
Tyler Labrum Individual W-2 Managing EmployeeAd; Jan 18, 2023
Kasandra Burk Heapes Individual W-2 Managing EmployeeVP of Operations Feb 1, 2024
Nicholas a Larsen Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 37.5%
General Partnership InterestBoard Member Sep 1, 2025 37.5%
Corporate Officer Sep 1, 2025 37.5%
Corporate Director Sep 1, 2025 37.5%
Sara Michelle Robinson Individual W-2 Managing EmployeeDirector of Nursing Sep 1, 2025

Practitioners & affiliated clinicians

Affiliated clinicians 30

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1902179302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 E BASELINE RD STE 127",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852095006",
            "telephone_number": "480-219-4790",
            "fax_number": "480-584-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7227 E BASELINE RD STE 127",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852095006",
            "telephone_number": "480-219-4790",
            "fax_number": "480-584-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS HOMECARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "435-754-4962"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA STATE LICENSE",
            "identifier": "HHA5406",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "746297",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVER",
            "identifier": "03D2038146",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aegis Homecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aegis Homecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.