Active NPI
Kim Bloomer
- Registered Dietitian
- Buffalo, NY
National Provider Identifier
1114400702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 005364-1
- Practice address
- 40 La Riviere Dr
Buffalo, NY 14202-4344 - Phone
- (716) 893-1010
- NPI assigned
- Sep 11, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 005364-1 | NY | Primary |
Addresses
Primary practice location
40 La Riviere Dr
Buffalo, NY 14202-4344
Mailing address
6835 Forestview Dr
Lockport, NY 14094-7988
Phone (716) 930-4422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005364-1 | Other | NY | NEW YORK STATE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005364-1 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kim M. Bloomer, Rd, CDN | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536624000000",
"number": "1114400702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6835 FORESTVIEW DR",
"city": "LOCKPORT",
"state": "NY",
"postal_code": "140947988",
"telephone_number": "716-930-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 LA RIVIERE DR",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142024344",
"telephone_number": "716-893-1010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOMER",
"first_name": "KIM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-11",
"last_updated": "2018-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "005364-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE",
"identifier": "005364-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.