Kerry L Bloomingdale, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

43793 Issued in MA

Practice address

1132 Westfield St
West Springfield, MA 01089-3878

Phone

(800) 378-5454

NPI assigned

Nov 2, 2005

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 7

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Harvard Medical School, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr IncGroup PAC ID 4486567104, shared by 12 NPIs, 1,693 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbloomingdale251772@direct.bilh.masshiway.net

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.

• Beth Israel Deaconess Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1548202641
  Medicare reassignment NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1194765438
  Medicare reassignment NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Psychiatry Physician
  • Boston, MA
  • NPI 1770524373
  Medicare reassignment NPD
• Beth Israel Deaconess Medical Center, Inc.

  • Ambulance
  • Boston, MA
  • NPI 1518600501
  NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Emergency Medicine Physician
  • Boston, MA
  • NPI 1316987993
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Beth Israel Deaconess Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1548202641
  Care Compare affiliation

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1326039181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015810260",
            "telephone_number": "508-898-8650",
            "fax_number": "508-870-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 WESTFIELD ST",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010893878",
            "telephone_number": "800-378-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMINGDALE",
        "first_name": "KERRY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "43793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "15-00675",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS MEDICARE PREFERRED",
            "identifier": "719405",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MASSACHUSETTS",
            "identifier": "C04856",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BC/BS",
            "identifier": "C04856",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "719405",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "O167959",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARD",
            "identifier": "C04856",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah A Bissonnette
• Hayley Bissonnette
• Desiree Ann Blaine-Skipton, MSW, LCSW
• Jade Blake
• Marina Rose Blokhin
• Blue Skies Therapy, LLC
• Jill Elizabeth Boggis, MSW, LICSW
• Cassandra Marie Boissonneault, APRN
• Sabrina Bolden
• Rene H Bonneau, DMD

• Psychiatry Physician in West Springfield, MA
• Providers in West Springfield, MA by specialty
• Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.