Nick Thomas Vander Bloomen, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10856 Issued in WI

Practice address

1505 North Dr
Oshkosh, WI 54901

Phone

(920) 426-4310

NPI assigned

Apr 30, 2021

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

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Wisconsin School of Medicine, 2011

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Bay Psychiatry of Wisconsin LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Egg Harbor, WI
  • NPI 1376438135
  Medicare reassignment

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

{
    "created_epoch": "1619740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1578146296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13936 ROSECRANS RD",
            "city": "MARIBEL",
            "state": "WI",
            "postal_code": "542279717",
            "telephone_number": "920-866-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTH DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "54901",
            "telephone_number": "920-426-4310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER BLOOMEN",
        "first_name": "NICK",
        "middle_name": "THOMAS",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-30",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "10856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Van Zeeland, LMFT-IT
• Teresa M Vanaacken, PT DPT OCS CSCS
• Brittany N Vanden Heuvel, APNP
• Jordan Vanden Heuvel
• Jamie D Vandenheuvel, APNP
• Tracy M Vanderhei, CNA
• Melissa Vandeyacht, APSW
• Breana M Vandoorn, CRNA
• Brooke Vanevenhoven, APNP
• Kaochi Desjheannette Vang, MS OTR

• Psychiatric/Mental Health Nurse Practitioner in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.