Bloom Healthcare

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLOOM HEALTHCARE

Practice address

954 Sedgefield CT
Maineville, OH 45039-7513

Phone

(970) 946-4607

NPI assigned

Dec 11, 2018

Last updated

Dec 11, 2018By 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

Debra K Wadelton

Title

Revenue Cycle Manager

Phone

(970) 946-4607

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1544486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544486400000",
    "number": "1033680400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10900 W 44TH AVE UNIT 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800332742",
            "telephone_number": "970-946-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 SEDGEFIELD CT",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450397513",
            "telephone_number": "970-946-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-11",
        "last_updated": "2018-12-11",
        "status": "A",
        "authorized_official_last_name": "WADELTON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "970-946-4607"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16108272",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Maineville, OH
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• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; 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.