Michael V Bloom, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

109 Issued in SD

Practice address

7920 Kirkland CT
Portage, MI 49024-4974

Phone

(269) 345-0669

Fax

(269) 345-5354

NPI assigned

Dec 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Michael V Bloom PHD LLC

  • Psychologist
  • Portage, MI
  • NPI 1073163580
  NPD Authorized official

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1477530392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3272",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486053272",
            "telephone_number": "989-797-1400",
            "fax_number": "989-797-4077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7920 KIRKLAND CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244974",
            "telephone_number": "269-345-0669",
            "fax_number": "269-345-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "MICHAEL",
        "middle_name": "V",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "SD",
            "license": "109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6550540",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark A Blazek, M.D.
• Shantel Lynn Bleeker, PA-C, RD
• Lisa Carrie Block, LMSW-C
• Kimberly Blok
• Gloria Bloom
• Lynnette Raye Blostica, O.D.
• Bluewater Counseling Services LLC
• Megan Bly, DPT, CLT
• Shiva Ram Boda
• Sneha Priya Boda

• Psychologist in Portage, MI
• Providers in Portage, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; 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.