Active NPI
Brandon D Wilde, D.P.M.
- Foot & Ankle Surgery Podiatrist
- Pocatello, ID
National Provider Identifier
1407169865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- P-217
- Practice address
- 1455 Bench Rd Ste B
Pocatello, ID 83201-5084 - Phone
- (208) 232-0006
- Fax
- (208) 233-8771
- NPI assigned
- Jul 14, 2010
- Last updated
- Mar 5, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | P-217 | ID | Primary |
Addresses
Primary practice location
1455 Bench Rd Ste B
Pocatello, ID 83201-5084
Mailing address
1455 Bench Rd
Suite B
Pocatello, ID 83201-5083
Phone (208) 232-0006
Other practice location 1
10 S 1st W Ste B
Preston, ID 83263-1244
Phone (208) 232-0006
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407169865 | Medicaid | MO | |
| P01271994 | Other | MO | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- College of Podiatric Med and Surgery, Des Moines University, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1455 Bench Rd
Suite B
Pocatello, ID 83201-5084
Phone (208) 232-0006
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 12 |
| Removal of tissue | 37 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 166 |
| Removal or shaving of skin growth | 53 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P-217 | ID | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Foot & Ankle, PC | Podiatrist | Current | Accepting new patients |
| Valley Foot & Ankle, PC | Podiatrist | Past | Accepting new patients |
| Idaho Surgicenter Inc | Foot & Ankle Surgery | Past | Accepting new patients |
Locations
1455 Bench Rd
#B
Pocatello, ID 83201
Phone (208) 232-0006
Interoperability endpoints
- bwilde262151@ahs.direct-ci.com
- bwilde910276@wm.providencedirect.org
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Podiatrist
- Pocatello, ID
- NPI 1790864619
-
- Podiatrist
- Pocatello, ID
- NPI 1669516738
-
dba Idaho SurgiCenter South
- Ambulatory Surgical Clinic/Center
- Pocatello, ID
- NPI 1992759930
Foot & Ankle Surgery
-
- Podiatrist
- Preston, ID
- NPI 1154238319
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Portneuf Rehabilitation Center
- Rehabilitation Hospital Unit
- Pocatello, ID
- NPI 1144262114
-
dba Portneuf Medical Center
- General Acute Care Hospital
- Pocatello, ID
- NPI 1790751055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772668800000",
"number": "1407169865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1455 BENCH RD",
"address_2": "SUITE B",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832015083",
"telephone_number": "208-232-0006",
"fax_number": "208-233-8771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1455 BENCH RD STE B",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832015084",
"telephone_number": "208-232-0006",
"fax_number": "208-233-8771"
}
],
"practiceLocations": [
{
"address_1": "10 S 1st W Ste B",
"address_purpose": "LOCATION",
"city": "Preston",
"state": "ID",
"postal_code": "832631244",
"country_code": "US",
"telephone_number": "208-232-0006",
"fax_number": "208-233-8771",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILDE",
"first_name": "BRANDON",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-14",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "ID",
"license": "P-217",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1407169865",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01271994",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.