Mary Jo Bloominger, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2550 24TH St
Rock Island, IL 61201-5304

Phone

(309) 793-4223

Fax

(309) 793-6276

NPI assigned

Jan 19, 2006

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IA

  Medicare reassignment

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1174503726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 24TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015304",
            "telephone_number": "309-793-4223",
            "fax_number": "309-793-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 24TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015304",
            "telephone_number": "309-793-4223",
            "fax_number": "309-793-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMINGER",
        "first_name": "MARY JO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-19",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "90720",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adriana Beverly, RN
• Chad Thomas Bishop
• Kelsie Blaesing
• Charles Rueben Blake III
• Cassandra Lynn Blondeau, BSW
• Sidney G Boersma, LCSW
• Paul Bolger
• Kaitlyn Marie Bonner, DPT
• Andrew William Boswell, D.C.
• Joseph Anthony Bowen, HEALTH TECHNICIAN

• Physician Assistant in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.