NPIMap

Individual provider Active NPI

Roger Earl Bloomer, MD

  • Family Medicine Physician
  • Jackson, MI
National Provider Identifier
1235196486
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301075147 Issued in MI
Practice address
2200 Springport Rd Ste 500
Jackson, MI 49202
Phone
(517) 205-3273
Fax
(517) 205-1698
NPI assigned
Apr 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 4301075147 MI
Family Medicine Physician 207Q00000X 4301075147 MI Primary

Addresses

Primary practice location

2200 Springport Rd Ste 500
Jackson, MI 49202

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-4806

Other practice location 1

153 Wamplers Lake Rd
Brooklyn, MI 49230-9585
Phone (517) 592-1963

Other identifiers 1

IdentifierTypeStateIssuer
104578484MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040325001323 MI Practitioner - Family Practice 3274425202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
W. a. Foote Memorial Hospital, Inc. 476 clinicians

Practice addresses (Care Compare)

400 Hinckley Blvd
Suite 100
Jackson, MI 49203-6152
Phone (517) 205-8991

Hospital & facility affiliations

  • Henry Ford Allegiance Home Care Home health agency, Jackson, MI, CCN 237405
  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue15
Removal of skin lesions14
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301075147MIMDUndersea and Hyperbaric Medicine (Preventive Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Pathology Current Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Jun 1, 2017 Accepting new patients
Wa Foote Memorial Hospital Inc Family Medicine CurrentSince Jun 1, 2017 Accepting new patients

Locations

153 Wamplers Lake Rd
Brooklyn, MI 49230
Phone (517) 205-2105

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

400 Hinckley Blvd
Ste 100
Jackson, MI 49203
Phone (517) 205-8991

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

704 E Michigan Ave
Jackson, MI 49201
Phone (517) 205-7683

2200 Springport Rd
Ste 500
Jackson, MI 49202
Phone (517) 205-2111

130 N Sherman St
Leslie, MI 49251
Phone (517) 205-2500

Interoperability endpoints

  • Direct secure messaging: rbloomer454391@direct.hfhs.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

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": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1235196486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 SPRINGPORT RD STE 500",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49202",
            "telephone_number": "517-205-3273",
            "fax_number": "517-205-1698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "153 Wamplers Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "MI",
            "postal_code": "492309585",
            "country_code": "US",
            "telephone_number": "517-592-1963",
            "fax_number": "517-592-1967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOOMER",
        "first_name": "ROGER",
        "middle_name": "EARL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "MI",
            "license": "4301075147",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301075147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104578484",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.