Andrew Bloom, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12012763A Issued in IN

Practice address

200 Medical Dr Ste a
Carmel, IN 46032-2985

Phone

(317) 575-1995

NPI assigned

May 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Bloom Dental Practice PLLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1487403838
  NPD Authorized official

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1417483876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12026 WOODS BAY CT",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460339524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL DR STE A",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460322985",
            "telephone_number": "317-575-1995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12026 Woods Bay Ct",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460339524",
            "country_code": "US",
            "telephone_number": "317-696-9011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-04",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012763A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Elizabeth Blettner, RN
• Melissa Susan Blix, CRNA
• Heather Angeline Blocher, PT
• Brandon Milo Block
• Bloom Behavioral Health, LLC
• Blossom Home Care Services LLC
• Joel C Boaz, M.D.
• Christina Diane Boccone, M.D.
• Heather Marie Bocek, BCBA
• Markian R Bochan, MD

• General Practice Dentistry in Carmel, IN
• Providers in Carmel, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.