Bloom Health LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BLOOM HEALTH LLC

Practice address

3184 River Valley Chase
West Friendship, MD 21794-9542

Phone

(443) 457-0699

Fax

(917) 268-9786

NPI assigned

Feb 27, 2024

Last updated

Feb 27, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Leviticus Williams III, MD, MBANPI 1659572956

Title

Ceo and Founder

Phone

(443) 457-0699

Specialties & licenses 3

Addresses

Locations

Practitioners 1

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.

• Samuel Leviticus Williams III, MD

  • Psychiatry Physician
  • Baltimore, MD
  • NPI 1659572956
  NPD Authorized official

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

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1154187193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 ELLICOTT CENTER DR",
            "address_2": "#697",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "21041",
            "telephone_number": "443-457-0699",
            "fax_number": "917-268-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3184 RIVER VALLEY CHASE",
            "city": "WEST FRIENDSHIP",
            "state": "MD",
            "postal_code": "217949542",
            "telephone_number": "443-457-0699",
            "fax_number": "917-268-9786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "LEVITICUS",
        "authorized_official_title_or_position": "CEO AND FOUNDER",
        "authorized_official_telephone_number": "443-457-0699",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD, MBA"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in West Friendship, MD
• Providers in West Friendship, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.