R Lamont Bloom MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

04-18702 Issued in KS

Legal business name

R LAMONT BLOOM MD PA

Practice address

406 E Central Ave
Wichita, KS 67202-1058

Phone

(316) 265-0705

Fax

(316) 265-0785

NPI assigned

Dec 1, 2011

Organization subpart

No

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

Authorized official

Name

Dr. R. Lamont Bloom, MDNPI 1225005879

Title

President

Phone

(316) 265-0705

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Tax ID family

R Lamont Bloom MD PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• R Lamont Bloom MD PA

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1477006518
  NPD tax ID

Locations

Practitioners 4

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

• R. Lamont Bloom, M.D.

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1225005879

  KS

  Medicare reassignment Authorized official
• Alexis Nicole Abasolo, APRN

  • Nurse Practitioner
  • Wichita, KS
  • NPI 1083537815
  NPD (past)
• Brittani Leigh Alumbaugh, APRN

  • Family Nurse Practitioner
  • Wichita, KS
  • NPI 1134696073
  NPD (past)
• Shana Stevens, MD

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1407860422
  NPD (past)

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

{
    "created_epoch": "1322697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1497023741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 E CENTRAL AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672021058",
            "telephone_number": "316-265-0705",
            "fax_number": "316-265-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 E CENTRAL AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672021058",
            "telephone_number": "316-265-0705",
            "fax_number": "316-265-0785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R LAMONT BLOOM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-01",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "R.",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "316-265-0705",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KS",
            "license": "04-18702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100195740A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rocio Esmeralda Quintana, COTA
• Kari Denise Quiring, LCPC
• R & K of Kansas LLC
• R and K of Kansas LLC
• R Lamont Bloom MD PA
• R2 Center for Dentistry GPS, LLC
• Laura Ann Raad, M.S., CCC-SLP
• Moussa Rabaoui
• Lucynda J Raben, D.D.S.
• Candyce C Rabourn, LMSW

• All providers in Wichita, KS
• Specialist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.