BRIDGEWAY INTEGRATED HEALTHCARE SERVICES INC — NPI 1104119619 (Licensed & Credentialed Behavior Analyst in TAYLORSVILLE, UT)

CMS-1500 Box 24J / 33a • NPI

1104119619

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103K00000X

Licensed & Credentialed Behavior Analyst

Box 32 Service Location & ZIP+4

6013 S REDWOOD RD, TAYLORSVILLE, UT, 84123-5220

✓ 9-Digit EDI 837 ZIP+4 (84123-5220)

Practice Phone & Referral Fax

(801) 255-5131

Fax: (801) 658-0604

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104119619 (BRIDGEWAY INTEGRATED HEALTHCARE SERVICES INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104119619` (NPI-2 Organization / Facility)
Provider / Legal Name	BRIDGEWAY INTEGRATED HEALTHCARE SERVICES INC
Plain-English Specialty	Licensed & Credentialed Behavior Analyst NUCC Code: `103K00000X` (Behavior Analyst)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	6013 S REDWOOD RD, TAYLORSVILLE, UT, 84123-5220
Practice Telephone / Fax	Tel: (801) 255-5131 \| Fax: (801) 658-0604
Administrative Mailing Address	6013 S REDWOOD RD, TAYLORSVILLE, UT, 84123-5220
Enumeration & Last Sync	Enumerated: 2011-05-17 \| CMS Record Updated: 2026-09-08
Authorized Official	NATALIE WHATCOTT (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

6013 S REDWOOD RD, TAYLORSVILLE, UT, 84123-5220

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Plain-English Taxonomy & CMS Crosswalk (103K00000X)

What Does Taxonomy Code 103K00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103K00000X translates to:
"Licensed & Credentialed Behavior Analyst"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Behavior Analyst for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BRIDGEWAY INTEGRATED HEALTHCARE SERVICES INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101Y00000X` — Counselor Plain English: Licensed & Credentialed Counselor	State: UT \| License: `5896085-6004` \| Primary: Secondary
`103K00000X` — Behavior Analyst Plain English: Licensed & Credentialed Behavior Analyst	State: UT \| License: `1-08-4502` \| Primary: Yes (Primary)
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: N/A \| License: `Verified` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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BRIDGEWAY INTEGRATED HEALTHCARE SERVICES INC (NPI #1104119619)