Active NPI
Graeme Philip Bloomfield, MD
- Pediatrics Physician
- Fort Moore, GA
National Provider Identifier
1205363140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0101265950
- Practice address
- 6600 Van Aalst Blvd
Fort Moore, GA 31905-2102 - Phone
- (660) 031-9057
- NPI assigned
- May 22, 2017
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0101265950 | VA | Primary |
Addresses
Primary practice location
6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
Mailing address
6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
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 |
|---|---|---|---|
| 0101265950 | VA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702339200000",
"number": "1205363140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6600 VAN AALST BLVD",
"city": "FORT MOORE",
"state": "GA",
"postal_code": "319052102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 VAN AALST BLVD",
"city": "FORT MOORE",
"state": "GA",
"postal_code": "319052102",
"telephone_number": "660-031-9057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOMFIELD",
"first_name": "GRAEME",
"middle_name": "PHILIP",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-22",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "VA",
"license": "0101265950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Moore, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.