Alex Bloom, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2330 Issued in OR

Practice address

8285 SW Nimbus Ave Ste 130
Beaverton, OR 97008-6428

Phone

(503) 610-2044

Fax

(503) 296-2102

NPI assigned

Dec 16, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alex.bloom.1@28621.direct.athenahealth.com

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.

• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178

  OR

  Medicare reassignment NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Eugene, OR
  • NPI 1316717747
  NPD
• Optum Behavioral Care of Colorado, P.C.

  • Professional Counselor
  • Portland, OR
  • NPI 1710711080
  NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Social Worker
  • De Pere, WI
  • NPI 1396622494
  NPD
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731
  NPD
• Eugene Therapy LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Eugene, OR
  • NPI 1295065530
  NPD (past)

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1124357306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 E 10TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013380",
            "telephone_number": "541-868-2004",
            "fax_number": "541-868-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8285 SW NIMBUS AVE STE 130",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970086428",
            "telephone_number": "503-610-2044",
            "fax_number": "503-296-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "ALEX",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-16",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164936",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "R0000WDBCH",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayne Lynne Blazevich
• Aedan Orion Blazina
• Bliss Care Residential Services
• Kelly Dawn Block, M.D.
• Sheryl Blodgett, PHARMD
• Arianna K Bloomfield
• Sally Bloomstrom
• Blue Tiger Massage LLC
• Madelyne Frances Rose Bluemmel, RDH
• Blueprint Sports Therapy

• Clinical Psychologist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.