Aegis Group Practice LLC

Primary specialty

Physical TherapistTaxonomy code 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

Last updated

Apr 7, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy McCall

Title

Credentialing

Phone

(479) 201-6091

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

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

  O20230717001935

  Same enrollment

Tax ID family

Marguerite Thompson PT216 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 1

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Aegis Group Practice LLC

  • Physical Therapist
  • Boise, ID
  • NPI 1346949443
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Aegis Therapies, Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Maysville, KY
  • NPI 1912370644

  Member Of

  NPD member

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.

• Elisa Bovenzi, OT

  • Pediatric Occupational Therapist
  • Boise, ID
  • NPI 1285888503
  NPD

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

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1972397891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4933 OLD GREENWOOD RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729036906",
            "telephone_number": "479-201-6091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3123 S TITANIUM AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428818",
            "telephone_number": "479-201-6091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS GROUP PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "MCCALL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "479-201-6091"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Open Imaging Boise LLC
• Advanced Pain Management PLLC
• Advanced Prosthetics and Orthotics LLC (Kormylo Orthopedic)
• Advanced PT LLC (Preferred PT Cherry Lane)
• Advantage Dental Center
• Aesthetic Smiles
• Aesthetic Smiles P LLC (Alpine Heights Dentistry)
• Ageless Women's Health Id LLC
• Yelizaveta Agiy
• Ann C Agnew, MD

• Physical Therapist in Meridian, ID
• Providers in Meridian, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; 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.

Verify at the official NPI Registry.