Leesa Robin Bloom

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

707 Broadway Blvd NE Ste 500
Albuquerque, NM 87102-2367

Phone

(505) 268-0701

NPI assigned

May 3, 2021

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 1, 2021.

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1104409689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1637",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423021637",
            "telephone_number": "270-689-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 BROADWAY BLVD NE STE 500",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022367",
            "telephone_number": "505-268-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "LEESA",
        "middle_name": "ROBIN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-06-01",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robyn Blomberg, RN
• Nicholas Louis Blonski, PT
• Bloom Bilingual Therapy LLC
• Bloom Trauma Therapy LLC
• Bloom Wellness Center, LLC
• Ricki Bloom, LMSW-P
• Bloome Healing LLC
• Jessica L Bloome, MA, LPCC
• Jason Corey Bloomer, MSN, RN, CCRN, FANAI
• Blooming Cactus Wellness LLC

• All providers in Albuquerque, NM
• Peer Specialist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.