Active NPI
Gary Allan Bloom, M.D.
- General Practice Physician
- Colorado Springs, CO
National Provider Identifier
1194947010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 17828
- Practice address
- 4190 E Woodmen Rd Ste 200
Colorado Springs, CO 80920-8075 - Phone
- (719) 265-6464
- Fax
- (719) 265-6750
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 17828 | CO | Primary |
Addresses
Primary practice location
4190 E Woodmen Rd Ste 200
Colorado Springs, CO 80920-8075
Mailing address
230 Shady Oak Grove
Coloradoo Springs, CO 80916
Phone (719) 321-4607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17828 | CO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242691200000",
"number": "1194947010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 SHADY OAK GROVE",
"city": "COLORADOO SPRINGS",
"state": "CO",
"postal_code": "80916",
"telephone_number": "719-321-4607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4190 E WOODMEN RD STE 200",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809208075",
"telephone_number": "719-265-6464",
"fax_number": "719-265-6750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "GARY",
"middle_name": "ALLAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2009-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CO",
"license": "17828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.