NPIMap

Organization Active NPI

Bloom Geriatrics LLC

  • Internal Medicine Physician
  • Chester, VA
National Provider Identifier
1013499623
Registry record updated Sep 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BLOOM GERIATRICS LLC
Practice address
1714 E Hundred Rd Ste 101
Chester, VA 23836-3310
Phone
(804) 590-6750
NPI assigned
Aug 30, 2018
Last updated
Sep 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2019

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

Authorized official

Name
Mohammad Farooq, MDNPI 1396704581
Title
President
Phone
(804) 590-6750

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1714 E Hundred Rd Ste 101
Chester, VA 23836-3310

Mailing address

PO Box 11768
Richmond, VA 23230-0168
Phone (804) 590-6750

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181213000168 VA Part B Supplier - Clinic/Group Practice 9537404967 Receives reassigned benefits from 12 practitioners
Practice locations: Chester, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567728000000",
    "number": "1013499623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11768",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232300168",
            "telephone_number": "804-590-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 E HUNDRED RD STE 101",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238363310",
            "telephone_number": "804-590-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM GERIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-30",
        "last_updated": "2019-09-06",
        "status": "A",
        "authorized_official_last_name": "FAROOQ",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-590-6750",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; 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.