Kenneth Edward Bloom, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

169466 Issued in NY

Practice address

1455 West Ave
Bronx, NY 10462-7304

Phone

(718) 239-1500

Fax

(212) 765-3210

NPI assigned

Nov 28, 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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Rush Medical College of Rush University, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

Interoperability endpoints

• Direct secure messaging: kenneth.bloom@ema.eclinicaldirectplus.com

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.

• Advanced Dermatology of New York PC

  • Dermatology Physician
  • New York, NY
  • NPI 1083610521
  Medicare reassignment NPD
• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087
  Medicare reassignment NPD
• Coney Island Medical Practice Plan, P.C.

  • General Practice Physician
  • Brooklyn, NY
  • NPI 1386951762
  Medicare reassignment NPD
• Essen Medical Associates, PC

  • Legal Medicine
  • Bronx, NY
  • NPI 1366418709
  Medicare reassignment NPD
• House Call Medical Services of New York, PLLC

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1851345946
  Medicare reassignment NPD
• Advanced Dermatology of New York PC

  • Dermatology Physician
  • Bronx, NY
  • NPI 1508048240
  NPD
• Advanced Dermatology of New York PC

  • Dermatology Physician
  • New York, NY
  • NPI 1588214357
  NPD
• Essen Medical Associates, PC

  • Podiatrist
  • Bronx, NY
  • NPI 1720799158
  NPD
• Essen Medical Associates,PC

  • Legal Medicine (M.D./D.O.) Physician
  • Jamaica, NY
  • NPI 1700023926
  NPD
• Shakespeare Operating LLC

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1720634538
  NPD
• Advanced Dermatology of New York PC

  • Dermatology Physician
  • Bronx, NY
  • NPI 1518964923
  NPD (past)
• Howard D. Solomon, DO, PC

  • Procedural Dermatology Physician
  • Forest Hills, NY
  • NPI 1598054520
  NPD (past)

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1477536068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CENTRAL PARK S APT 107",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191449",
            "telephone_number": "212-262-2500",
            "fax_number": "212-765-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 WEST AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104627304",
            "telephone_number": "718-239-1500",
            "fax_number": "212-765-3210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2432 Grand Concourse Rm 501",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104585204",
            "country_code": "US",
            "telephone_number": "718-537-5000",
            "fax_number": "212-765-3210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "291 E 149th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104515601",
            "country_code": "US",
            "telephone_number": "718-671-1000",
            "fax_number": "212-765-3210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2100 Bartow Ave Ste 211",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104754614",
            "country_code": "US",
            "telephone_number": "718-671-1000",
            "fax_number": "212-765-3210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "KENNETH",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "169466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04134401",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blondell RX Ny LLC
• Jacques Oswald Blondet, DPM
• Bloom Services LLC
• Bloom Trans Services LLC
• Kelly Bloom
• Rita Marie Bloom
• Diane E Bloomfield, MD
• Noah Aaron Bloomgarden, M.D.
• Luna L Blossom
• Blossoming Scolars, Inc

• Dermatology Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.