Henry R Bloom, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-039371 Issued in OH

Practice address

20620 John Carroll Blvd
Suite 208
University Heights, OH 44118-4540

Phone

(216) 321-9703

Fax

(216) 321-9704

NPI assigned

Dec 30, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: hbloom35959@ehrdirect.uhhospitals.org

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342396800000",
    "number": "1003893025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20620 JOHN CARROLL BLVD",
            "address_2": "SUITE 208",
            "city": "UNIVERSITY HEIGHTS",
            "state": "OH",
            "postal_code": "441184540",
            "telephone_number": "216-321-9703",
            "fax_number": "216-321-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20620 JOHN CARROLL BLVD",
            "address_2": "SUITE 208",
            "city": "UNIVERSITY HEIGHTS",
            "state": "OH",
            "postal_code": "441184540",
            "telephone_number": "216-321-9703",
            "fax_number": "216-321-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "HENRY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2012-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-039371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3059621",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0394130",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Taylor Berntson
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• Bluestone Child and Adolescent Psychiatric Hospital
• Emma Bogard, M.S.S.A., L.I.S.W.-S
• Yerucham Boim
• Sarah Brody

• Family Medicine Physician in University Heights, OH
• Providers in University Heights, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.