Bloom Primary TX, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

P2012 Issued in TX

Legal business name

BLOOM PRIMARY TX, PLLC

Practice address

545 S Nolen Dr
Southlake, TX 76092-9176

Phone

(303) 993-1330

NPI assigned

Sep 8, 2015

Last updated

Sep 21, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debra Kay Moon Wadelton

Title

Authorized Official

Phone

(720) 923-1250

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Paul Capper, MD

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1720075690
  Medicare reassignment Care Compare group NPD
• Kimberly A Hilmer, FNP

  • Family Nurse Practitioner
  • Aledo, TX
  • NPI 1902021850
  Medicare reassignment Care Compare group NPD
• Taylor Markham, APRN

  • Nurse Practitioner
  • Fort Worth, TX
  • NPI 1255074076
  Medicare reassignment Care Compare group NPD
• Payton Marie Okelly, NP

  • Nurse Practitioner
  • Burleson, TX
  • NPI 1912778275
  Medicare reassignment Care Compare group NPD
• Karen S Kotara, PA

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1073606810
  Medicare reassignment Care Compare group
• Ashley Mae Collins, FNP

  • Family Nurse Practitioner
  • Abilene, TX
  • NPI 1174108401
  Medicare reassignment NPD

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

{
    "created_epoch": "1441670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789948800000",
    "number": "1275901340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12600 W COLFAX AVE STE B200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802153736",
            "telephone_number": "303-993-1330",
            "fax_number": "303-284-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 S NOLEN DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929176",
            "telephone_number": "303-993-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PRIMARY TX, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-08",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A",
        "authorized_official_last_name": "MOON WADELTON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "720-923-1250"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P2012",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "617313",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Black, MA, LPC
• Jeanne Marie Blakeslee, PMHNP
• Derek C Blankenship, M.D.
• Angelica Bledsoe, RBT
• Bloom Primary TX II, PA
• Blue Ocean Health Services LLC
• Blue Ridge Medical Solutions LLC
• Ashley Bobb
• Bobbye Records LLC
• Michael A Bogdan, MD, FACS

• Family Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.