Individual provider Active NPI

Jerry L Buie, LCSW

  • Clinical Social Worker
  • Salt Lake City, UT
National Provider Identifier
1174599393
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
140182-3501 Issued in UT
Practice address
1174 E Graystone Way Ste 20E
Salt Lake City, UT 84106-2678
Phone
(801) 595-0666
Fax
(801) 595-0669
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 140182-3501 UT Primary

Addresses

Primary practice location

1174 E Graystone Way Ste 20E
Salt Lake City, UT 84106-2678

Mailing address

1174 E Graystone Way Ste 20E
Salt Lake City, UT 84106-2678
Phone (801) 595-0666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050406000260 UT Practitioner - Clinical Social Worker 0547217291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Utah School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1174 E Graystone Way
20E
Salt Lake City, UT 84106-2673
Phone (801) 595-0666

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pride Counseling Inc Clinical CurrentSince Jun 23, 2003 Accepting new patients

Locations

124 S 400 E
Ste 230
Salt Lake City, UT 84111
Phone (801) 597-5686

1174 E Graystone Way
Ste 20E
Salt Lake Cty, UT 84106
Phone (435) 770-7813

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1174599393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1174 E GRAYSTONE WAY STE 20E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062678",
            "telephone_number": "801-595-0666",
            "fax_number": "801-595-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1174 E GRAYSTONE WAY STE 20E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062678",
            "telephone_number": "801-595-0666",
            "fax_number": "801-595-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUIE",
        "first_name": "JERRY",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "140182-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.