Genevieve E Bloom, M.D.
Individual provider Active NPI Internal Medicine Physician · Coronado, CA
NPI 1376537076 · NPPES record last updated Nov 4, 2010
Key facts
- NPI
- 1376537076
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- A55250 (CA)
- Practice address
- 1117 10TH St
Coronado, CA 92118-3401 - Phone
- (619) 435-0268
- Fax
- (619) 435-1420
- NPI assigned
- Sep 8, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Loma Linda University School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1117 10TH St
Coronado, CA 92118-3401
Phone (619) 435-0268
Hospital & facility affiliations
- Sharp Coronado Hospital and Hlthcr Ctr
- Grossmont Hospital
- Sharp Chula Vista Medical Center
- Sharp Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110616000397 | CA | Practitioner - Internal Medicine | 8224216411 |
Reassigns benefits to 1 organization Practice locations: Coronado, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55250 | CA | MD | Dentist |
| A55250 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency and Acute Care Medical Corporation | Current |
Accepting new patients |
Locations
7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400
250 Prospect Pl
San Diego, CA 92118
Phone (619) 522-3600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A55250 | CA | Yes |
Addresses
Primary practice location
1117 10TH St
Coronado, CA 92118-3401
Mailing address
1117 10TH St
Coronado, CA 92118-3401
Phone (619) 435-0268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A552500 | Medicaid | CA |
Other providers in Coronado, CA
- Lynn D Berger
- Tejal Bhikha
- Eric Bianchini
- William John Bigham
- Kris M. Bjornson
- John A Bodnar
- Jessica Morgan Bogle
- Obel Borrajero
- Sandra Jill Boyce
- Johan Merle Brandl Amundson
All providers in Coronado, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.