NPIMap

Organization Active NPI

Bloom Wellness LLC

  • Clinical Social Worker
  • Green Mountain Falls, CO
National Provider Identifier
1114723558
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BLOOM WELLNESS LLC
Practice address
10585 Ute Pass Avenue
Green Mountain Falls, CO 80809
Phone
(719) 286-9077
NPI assigned
Feb 24, 2025
Last updated
Feb 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BLOOM WELLNESS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Authorized official

Name
Laura Magnuson, LCSWNPI 1881093839
Title
Owner/Clinician
Phone
(719) 286-9077

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 Worker 1041C0700X Primary

Addresses

Primary practice location

10585 Ute Pass Avenue
Green Mountain Falls, CO 80809

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230927003392 CO Part B Supplier - Clinic/Group Practice 5294189080 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cripple Creek, CO; Green Mountain Falls, CO; Woodland Park, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1114723558",
    "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": "10585 UTE PASS AVENUE",
            "city": "GREEN MOUNTAIN FALLS",
            "state": "CO",
            "postal_code": "80809",
            "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": "2025-02-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "MAGNUSON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER/CLINICIAN",
        "authorized_official_telephone_number": "719-286-9077",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Mountain Falls, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.