NPIMap

Individual provider Active NPI

Nathan Michael Bloom, MD

  • Family Medicine Physician
  • Lawrence, KS
National Provider Identifier
1164629218
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0432319 Issued in KS
Practice address
4921 W 18TH St
Lawrence, KS 66047-2090
Phone
(785) 830-0100
Fax
(785) 830-0115
NPI assigned
Jul 2, 2007
Last updated
Dec 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9406871 KS
Family Medicine Physician 207Q00000X 0432319 KS Primary

Addresses

Primary practice location

4921 W 18TH St
Lawrence, KS 66047-2090

Mailing address

4921 W 18TH St
Lawrence, KS 66047-2090
Phone (785) 830-0100

Other identifiers 1

IdentifierTypeStateIssuer
200672020AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20100915001103 KS Practitioner - Family Practice 3476678376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9301 W 74TH St
100 Ahmg Hematology Oncology at Shawnee
Merriam, KS 66204-2217
Phone (913) 632-9100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9406871KSMDFamily Medicine Physician
0432319KSMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Mission Medical Center Inc Family Medicine CurrentSince Aug 12, 2021 Accepting new patients

Locations

9301 W 74th St
Ste 100
Shawnee Mission, KS 66204
Phone (913) 632-9100

9100 W 74th St
Shawnee Msn, KS 66204
Phone (913) 632-2230

Interoperability endpoints

  • Direct secure messaging: nbloom661362@adventhealth.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1164629218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 W 18TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660472090",
            "telephone_number": "785-830-0100",
            "fax_number": "785-830-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 W 18TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660472090",
            "telephone_number": "785-830-0100",
            "fax_number": "785-830-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "NATHAN",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "9406871",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0432319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200672020A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, KS

Sources for this page

Verify at the official NPI Registry.