NPIMap

Organization Active NPI

Bloom Hospice LLC

  • Community Based Hospice Care Agency
  • Lakewood, CO
National Provider Identifier
1093470684
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BLOOM HOSPICE LLC
Practice address
12600 W Colfax Ave Ste B200
Lakewood, CO 80215-3736
Phone
(303) 459-4000
Fax
(720) 912-3300
NPI assigned
Nov 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Authorized official

Name
John Freeman
Title
President
Phone
(303) 459-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

12600 W Colfax Ave Ste B200
Lakewood, CO 80215-3736

Mailing address

12600 W Colfax Ave Ste B200
Lakewood, CO 80215-3736
Phone (303) 459-4000

Other names 1

  • BLOOM HOSPICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220210000948 CO Part A Provider - Hospice 7810380060 Practice locations: Lakewood, CO

Hospice certification: CCN 061618

Legal name
BLOOM HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 7, 2022
Last certification
Apr 7, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Nov 1, 2021 in CO
Enrollment address
12600 W Colfax Ave
Ste B200
Lakewood, CO 80215-3736

Care Compare: Hospice

Medicare Care Compare
Listed as
Bloom HospiceCCN 061618
Ownership
For-Profit
Certified
Apr 7, 2022
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2252645Bloom Hospice12600 W Colfax Ave, Suite B-200, Lakewood, CO 80215Certificate of waiverFeb 13, 2028

National Provider Directory

National Provider Directory

Locations

10900 W 44th Ave
Unit 102
Wheat Ridge, CO 80033

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas J Lally Individual 5% Or Greater Indirect Ownership Interest20% Owner of Bloom Healthcare Inc Nov 1, 2021 20%
John L Freeman Individual 5% Or Greater Indirect Ownership InterestOwner- 20% Bloom Healthcare Inc Nov 1, 2021 20%
Corporate OfficerCeo/ President Nov 1, 2021 100%
W-2 Managing EmployeeCeo/ President Nov 1, 2021 100%
Franke P Elliott Individual 5% Or Greater Indirect Ownership Interest10% Ownership- Bloom Healthcare Inc Nov 1, 2021 10%
Michael Bunting Individual 5% Or Greater Indirect Ownership Interest7% Ownership- Bloom Healthcare Inc Nov 1, 2021 7%
Bloom Healthcare Organization, Lakewood, CO Corporation, Medical provider/supplier, For-profit 5% Or Greater Direct Ownership Interest Nov 1, 2021 100%
Jeanine Lally Individual 5% Or Greater Indirect Ownership Interest20% Ownership- Bloom Healthcare Inc Nov 1, 2021 20%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 81

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1093470684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12600 W COLFAX AVE STE B200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802153736",
            "telephone_number": "303-459-4000",
            "fax_number": "720-912-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12600 W COLFAX AVE STE B200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802153736",
            "telephone_number": "303-459-4000",
            "fax_number": "720-912-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-08",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-459-4000"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BLOOM HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.