Michael a. Bloom D.M.D. PLLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

D3394 Issued in ID

Legal business name

MICHAEL A. BLOOM D.M.D. PLLC

Practice address

9928 N Government Way
Hayden Lake, ID 83835-9604

Phone

(208) 772-3583

Fax

(208) 772-3224

NPI assigned

May 7, 2013

Last updated

May 7, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kathy L. Marks

Title

Office Manager

Phone

(208) 772-3583

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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.

• Michael Aaron Bloom, DMD

  • General Practice Dentistry
  • Hayden, ID
  • NPI 1366527780
  NPD (past)

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1033554845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 425",
            "city": "HAYDEN LAKE",
            "state": "ID",
            "postal_code": "838350425",
            "telephone_number": "208-772-3583",
            "fax_number": "208-772-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9928 N GOVERNMENT WAY",
            "city": "HAYDEN LAKE",
            "state": "ID",
            "postal_code": "838359604",
            "telephone_number": "208-772-3583",
            "fax_number": "208-772-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL A. BLOOM D.M.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-772-3583",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "ID",
            "license": "D3555",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "ID",
            "license": "D3394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Kitchen, LMP
• See Yan Lau, PHARM.D
• Deborah Jean Long, A.R.N.P.
• Betty J Magnus, LCPC
• Medical Consulting Services, LLC (Medical Consulting Services)
• Renee Palmer, APRN, CNP
• Treasure Valley Neurotherapy LLC
• Stanley Keith Wacholz, BS BIS

• Health Maintenance Organization in Hayden Lake, ID
• Providers in Hayden Lake, ID by specialty
• Health Maintenance Organization in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.