Caitlin Bloomer, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1001838-15 Issued in WI

Practice address

2011 Wisconsin Ave
New Holstein, WI 53061-1316

Phone

(920) 645-1219

NPI assigned

Jun 18, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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.

• Mt Calvary Dental LLC

  • Dental Clinic/Center
  • Mount Calvary, WI
  • NPI 1780288977
  NPD Authorized official

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1457845133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W5571 GLADWATER BEACH RD",
            "city": "MALONE",
            "state": "WI",
            "postal_code": "530491113",
            "telephone_number": "920-645-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 WISCONSIN AVE",
            "city": "NEW HOLSTEIN",
            "state": "WI",
            "postal_code": "530611316",
            "telephone_number": "920-645-1219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "403 Fremont St",
            "address_purpose": "LOCATION",
            "city": "Kiel",
            "state": "WI",
            "postal_code": "530421316",
            "country_code": "US",
            "telephone_number": "920-894-2305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOOMER",
        "first_name": "CAITLIN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-18",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001838-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• American Home Nursing, LLC
• Ascension Medical Group-Fox Valley Wisconsin, Inc (Ascension Medical Group)
• Assisted Living Concepts Inc (Willowpark Residence)
• Back in Action Rehabilitation
• Bradley S Baus, DDS
• Thomas George Brandt, DDS SC
• Calumet Homestead Rehabilitation Center
• Wendy Clark, SLP
• Alec M Compton, OD
• Joseph Allen Delgado, OD

• General Practice Dentistry in New Holstein, WI
• Providers in New Holstein, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.