Aegis Group Practice LLC – Physical Therapist

Key facts

NPI: 1972397891
Entity type: Organization (NPI type 2)
Primary specialty: Physical Therapist 225100000X
Legal business name: AEGIS GROUP PRACTICE LLC
Practice address: 3123 S Titanium Ave
Meridian, ID 83642-8818
Phone: (479) 201-6091
NPI assigned: Apr 7, 2025
Organization subpart: No

Authorized official

Name: Tracy McCall
Title: Credentialing
Phone: (479) 201-6091

Other NPIs on the same Medicare enrollment 1

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

Aegis Group Practice LLC Physical Therapist · Boise, ID · NPI 1346949443

Same enrollment O20230717001935

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Aegis Group Practice LLC Physical Therapist · Boise, ID · NPI 1346949443

NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Elisa Bovenzi, OT Pediatric Occupational Therapist · Boise, ID · NPI 1285888503

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in ID

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20230717001935	ID	Part B Supplier - Clinic/Group Practice	5193036432	Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boise, ID; Meridian, ID

National Provider Directory

Tax ID family: Aegis Group Practice (204 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)	Code	Primary
Physical Therapist Group: 193200000X MULTI-SPECIALTY GROUP	225100000X	Yes
Occupational Therapist Group: 193200000X MULTI-SPECIALTY GROUP	225X00000X
Speech-Language Pathologist Group: 193200000X MULTI-SPECIALTY GROUP	235Z00000X

Addresses

Primary practice location

3123 S Titanium Ave
Meridian, ID 83642-8818

Mailing address

4933 Old Greenwood Rd
Fort Smith, AR 72903-6906
Phone (479) 201-6091

Other providers in Meridian, ID

All providers in Meridian, ID · Physical Therapist in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.