NPIMap

Organization Active NPI

Desertbloom Medical LLC

  • Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1376323550
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DESERTBLOOM MEDICAL LLC
Practice address
931 S 3Rd St
Las Vegas, NV 89101-6801
Phone
(725) 256-8020
NPI assigned
Oct 4, 2023
Last updated
Oct 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Asya Hovhannisyan
Title
Owner
Phone
(725) 256-8020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

931 S 3Rd St
Las Vegas, NV 89101-6801

Mailing address

931 S 3Rd St
Las Vegas, NV 89101-6801
Phone (725) 256-8020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240425002472 NV Part B Supplier - Clinic/Group Practice 5597105411 Receives reassigned benefits from 6 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

931 S 3rd St
Las Vegas, NV 89101
Phone (702) 268-7522

301 Oxbow Ave
Ste 14
Pahrump, NV 89048

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1376323550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 S 3RD ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891016801",
            "telephone_number": "725-256-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 S 3RD ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891016801",
            "telephone_number": "725-256-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERTBLOOM MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-04",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "HOVHANNISYAN",
        "authorized_official_first_name": "ASYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "725-256-8020"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.