Individual provider Active NPI

Brady Kielgas, PT, DPT, CERT. DN

  • Physical Therapist
  • Salt Lake City, UT
National Provider Identifier
1487302121
Registry record updated Jan 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
114038122401 Issued in UT
Practice address
159 W Broadway Ste 200
Salt Lake City, UT 84101-1923
Phone
(866) 839-6979
NPI assigned
Mar 11, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 114038122401 UT Primary

Addresses

Primary practice location

159 W Broadway Ste 200
Salt Lake City, UT 84101-1923

Mailing address

159 W Broadway Ste 200
Salt Lake City, UT 84101-1923
Phone (866) 839-6979

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BKIELGAS582424@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220401000969 UT Practitioner - Physical Therapist in Private Practice 1153717079 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
114038122401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Luna Care Physical Therapy LLC Physical Therapist CurrentSince Mar 24, 2022 Accepting new patients
University of Utah CurrentSince Sep 13, 2022 Accepting new patients
University of Utah CurrentSince Sep 13, 2022 Accepting new patients

Locations

159 W Broadway
Ste 200
Salt Lake City, UT 84101
Phone (404) 408-5442

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: bkielgas582424@direct.med.utah.edu

Organizations & group practices 3

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": "1646956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673136000000",
    "number": "1487302121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 W BROADWAY STE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841011923",
            "telephone_number": "866-839-6979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 W BROADWAY STE 200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841011923",
            "telephone_number": "866-839-6979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIELGAS",
        "first_name": "BRADY",
        "credential": "PT, DPT, CERT. DN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-11",
        "last_updated": "2023-01-08",
        "certification_date": "2023-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "114038122401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BKIELGAS582424@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2023; 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.