Bloom Primary Mo II, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLOOM PRIMARY MO II, LLC

Practice address

540 Maryville Centre Dr Ste 340
Saint Louis, MO 63141-5831

Phone

(303) 993-1330

NPI assigned

Aug 6, 2026

Organization subpart

No

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

Authorized official

Name

Debra Kay Moon Wadelton

Title

Authorized Official

Phone

(720) 923-1250

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Compton, M.D.

  • Family Medicine Physician
  • Saint Louis, MO
  • NPI 1174567176
  NPD (past)
• Phylicia Little, FNP-BC

  • Family Nurse Practitioner
  • Maryland Heights, MO
  • NPI 1053782276
  NPD (past)
• Danielle Ann Whitacre, M.D.

  • Family Medicine Physician
  • Lakewood, CO
  • NPI 1134316540
  NPD (past)

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

{
    "created_epoch": "1785974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1417871013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12600 W COLFAX AVE STE 200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802153733",
            "telephone_number": "303-993-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MARYVILLE CENTRE DR STE 340",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415831",
            "telephone_number": "303-993-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PRIMARY MO II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-06",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "MOON WADELTON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "720-923-1250"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Ann Blomberg, LICSW
• Lara Allison Menke Blomgren
• Robyn Blood, MD
• Amanda Bloodworth, LPC
• Bloom Home Healthcare LLC
• Bloom Primary Mo, LLC
• Bloom Within Counseling, LLC
• Ilene Linda Bloom-Ellis, MSW, LCSW, ACSW
• Michelle Marie Bloom, ACNP
• Gordon R Bloomberg, MD

• All providers in Saint Louis, MO
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; 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.