Individual provider Active NPI

Bryan K. Wilde, LCSW

  • Clinical Social Worker
  • Taylorsville, UT
National Provider Identifier
1942430863
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
365238-3501 Issued in UT
Practice address
5770 S 1500 W Ste 105
Taylorsville, UT 84123-5216
Phone
(801) 313-7770
Fax
(801) 313-7771
NPI assigned
Jul 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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 365238-3501 UT Primary

Addresses

Primary practice location

5770 S 1500 W Ste 105
Taylorsville, UT 84123-5216

Mailing address

PO Box 27128
Suite 105
Salt Lake City, UT 84127-0128

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

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
I20251124002839 UT Practitioner - Clinical Social Worker 8325530686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1208 King St
Suite 405
Chattanooga, TN 37403-4352

PO Box
Suite 27128
Salt Lake City, UT 84127

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
365238-3501UTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Nov 5, 2025 Accepting new patients
Ihc Health Services Inc CurrentSince Nov 5, 2025 Accepting new patients
Ihc Health Services Inc Current Accepting new patients

Locations

1225 E Fort Union Blvd
Ste 315
Midvale, UT 84047
Phone (801) 233-4100

5770 S 1500 W
Taylorsville, UT 84123
Phone (801) 265-3000

5770 S 1500 W
Ste 105
Taylorsville, UT 84123
Phone (801) 313-7770

1300 SE Cardinal Ct
Ste 190
Vancouver, WA 98683
Phone (360) 448-4479

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": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1942430863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "address_2": "SUITE 105",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 S 1500 W STE 105",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235216",
            "telephone_number": "801-313-7770",
            "fax_number": "801-313-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "BRYAN",
        "middle_name": "K.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-27",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "365238-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Taylorsville, UT

Sources for this page

Verify at the official NPI Registry.