Staci Bloom, PH.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

7777 Forest LN
Suite B-326
Dallas, TX 75230-2505

Phone

(972) 566-8466

NPI assigned

Sep 8, 2009

Last updated

Sep 8, 2009By the provider in NPPES

Sex

Female

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)

Not enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Genecov Physician Group

  • Developmental - Behavioral Pediatrics Physician
  • Dallas, TX
  • NPI 1013937598
  NPD (past)

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252368000000",
    "number": "1306179460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN",
            "address_2": "SUITE B-326",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302505",
            "telephone_number": "972-566-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN",
            "address_2": "SUITE B-326",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302505",
            "telephone_number": "972-566-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "STACI",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-08",
        "last_updated": "2009-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL CERTIFICATION FOR SCHOOL PSYCHOLOGISTS",
            "identifier": "38529",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blood and Marrow Transplant Services
• Bloom Integrative Wellness Center of South Lake, LLC (Bloom Integrative Wellness Center)
• Bloom Speech and Language Therapy
• Christopher A. Bloom, MD
• Kristy Bloom, PT
• Steven L Bloom, MD
• Kerry Bradford Bloomer, OTR
• Corben P Bloomfield, LPC
• Gary M Bloomgarden, MD
• Blooming Minds Psychiatry PLLC

• Student in an Organized Health Care Education/Training Program in Dallas, TX
• Providers in Dallas, TX by specialty
• Student in an Organized Health Care Education/Training Program in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.

Verify at the official NPI Registry.