NPIMap

Individual provider Active NPI

Jeffrey M Bloom, MD

  • Internal Medicine Physician
  • San Luis Obispo, CA
National Provider Identifier
1154346377
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G72622 Issued in CA
Practice address
1318 Johnson Ave
San Luis Obispo, CA 93401-3314
Phone
(805) 541-2300
Fax
(805) 541-2301
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G72622 CA Primary

Addresses

Primary practice location

1318 Johnson Ave
San Luis Obispo, CA 93401-3314

Mailing address

1318 Johnson Ave
San Luis Obispo, CA 93401-3314
Phone (805) 541-2300

Other identifiers 1

IdentifierTypeStateIssuer
00G726221MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100323000500 CA Practitioner - Internal Medicine 4789637356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1318 Johnson Ave
San Luis Obispo, CA 93401-3314
Phone (805) 541-2300

Hospital & facility affiliations

  • Central Coast Home Health Inc Home health agency, San Luis Obispo, CA, CCN 059010
  • Dignity Health Home Health Home health agency, Santa Maria, CA, CCN 557038
  • Aevum Home Health Home health agency, San Luis Obispo, CA, CCN 559787
  • Central Coast Home Health, Inc Hospice, San Luis Obispo, CA, CCN 551604
  • French Hospital Medical Center Hospital, San Luis Obispo, CA, CCN 050232
  • Marian Regional Medical Center Hospital, Santa Maria, CA, CCN 050107
  • Adventist Health Sierra Vista Hospital, San Luis Obispo, CA, CCN 050506

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G72622CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey M. Bloom M.D. Inc Internal Medicine CurrentSince Jan 6, 2014 Accepting new patients
Central Rehabilitation Clinic Inc Internal Medicine CurrentSince Mar 14, 2010 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Dignity Community Care Past Accepting new patients
Eric Dunlop, DO, Inc. Past Accepting new patients

Locations

1241 Johnson Ave
Sn Luis Obisp, CA 93401
Phone (404) 790-0911

1334 Marsh St
Sn Luis Obisp, CA 93401
Phone (805) 543-2724

1318 Johnson Ave
Sn Luis Obisp, CA 93401
Phone (805) 541-2300

Interoperability endpoints

  • Direct secure messaging: jeffrey.bloom@36427079221252.direct.elationemr.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1154346377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013314",
            "telephone_number": "805-541-2300",
            "fax_number": "805-541-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013314",
            "telephone_number": "805-541-2300",
            "fax_number": "805-541-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G72622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G726221",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.