NPIMap

Organization Active NPI

Bloom Wellness LLC

  • Clinical Social Worker
  • Cripple Creek, CO
National Provider Identifier
1093523904
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BLOOM WELLNESS LLC
Practice address
100 W Bennett Avenue
Cripple Creek, CO 80813
Phone
(719) 286-9077
NPI assigned
Dec 23, 2024
Organization subpart
Yes
Parent organization
BLOOM WELLNESS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Authorized official

Name
Laura Magnuson, LSCWNPI 1881093839
Title
Owner, Supervisor, Clinician
Phone
(303) 408-8056

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
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

100 W Bennett Avenue
Cripple Creek, CO 80813

Mailing address

417 Beaver Pond Rd
Divide, CO 80814-7792
Phone (719) 286-9077

National Provider Directory

National Provider Directory
Tax ID family
Bloom Wellness LLC5 organizations share this tax ID, including this one
Part of
Bloom Wellness LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1734912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1093523904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 BEAVER POND RD",
            "city": "DIVIDE",
            "state": "CO",
            "postal_code": "808147792",
            "telephone_number": "719-286-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W BENNETT AVENUE",
            "city": "CRIPPLE CREEK",
            "state": "CO",
            "postal_code": "80813",
            "telephone_number": "719-286-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLOOM WELLNESS LLC",
        "enumeration_date": "2024-12-23",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "MAGNUSON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER, SUPERVISOR, CLINICIAN",
        "authorized_official_telephone_number": "303-408-8056",
        "authorized_official_credential": "LSCW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cripple Creek, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; 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.