Bloom Wellness Direct Primary Care, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLOOM WELLNESS DIRECT PRIMARY CARE, PLLC

Practice address

7112 Highland Rd
Waterford, MI 48327-1503

Phone

(248) 509-0055

Fax

(626) 517-5630

NPI assigned

Apr 10, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Blerta Lici Gaqi, DONPI 1588103865

Title

Family Medicine

Phone

(248) 509-0055

Specialties & licenses 1

Addresses

Other names 1

• Blerta Gaqi Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Blerta Lici Gaqi, DO

  • Family Medicine Physician
  • Waterford, MI
  • NPI 1588103865

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1447003108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7112 HIGHLAND RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271503",
            "telephone_number": "248-509-0055",
            "fax_number": "626-517-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7112 HIGHLAND RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271503",
            "telephone_number": "248-509-0055",
            "fax_number": "626-517-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM WELLNESS DIRECT PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "GAQI",
        "authorized_official_first_name": "BLERTA",
        "authorized_official_middle_name": "LICI",
        "authorized_official_title_or_position": "FAMILY MEDICINE",
        "authorized_official_telephone_number": "248-509-0055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blerta Gaqi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa A Blake, OTR
• Stephen Joseph Blake Sr., DDS
• Joshua Andrew Blanden, CPSS
• Jacqueline Bleisch
• Jessica Louise Blodgett, LLPC
• Neil L Bluestone, R.PH
• Board of Education Oakland County
• Alyssa Lynn Boinais, LLMSW
• Richard Carl Bolten, DDS
• Ethan Glenn Bond

• Family Medicine Physician in Waterford, MI
• Providers in Waterford, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.