Charles Stephen Bloom, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

40849 Issued in FL

Practice address

1371 Harmon Ave
Winter Park, FL 32789-5512

Phone

(321) 794-4747

Fax

(407) 740-5251

NPI assigned

Feb 5, 2007

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Florida Department of Health

  • Public Health or Welfare Agency
  • Viera, FL
  • NPI 1386751907
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380672000000",
    "number": "1285773457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1371 HARMON AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895512",
            "telephone_number": "321-794-4747",
            "fax_number": "321-794-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1371 HARMON AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895512",
            "telephone_number": "321-794-4747",
            "fax_number": "407-740-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "CHARLES",
        "middle_name": "STEPHEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2013-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "40849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008921300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John L Blankemeier, MD
• Ikram Blaoui
• Gage Bleiler, RMHCI
• Blessings Woman'S Care & Medical Spa
• David Lyle Bloodgood, LMHC
• Jennifer Hanson Bloom, LMFT
• Blooming Behavior Therapy LLC
• Carol L Bloomquist Mikulka, M.D.
• Blue Horizon Eating Disorder Services, LLC
• Blue Ocean Deramtology LLC

• Obstetrics & Gynecology Physician in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.