NPIMap

Individual provider Active NPI

David Alan Bloom, MD

  • Urology Physician
  • Ann Arbor, MI
National Provider Identifier
1609967132
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4301047893 Issued in MI
Practice address
1500 E Medical Center Dr
4TH Floor Clinic B Room 4807
Ann Arbor, MI 48109-4217
Phone
(734) 936-7030
NPI assigned
Sep 28, 2006
Last updated
Apr 24, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301047893 MI
Urology Physician 208800000X 4301047893 MI Primary
Pediatric Urology Physician 2088P0231X 4301047893 MI

Addresses

Primary practice location

1500 E Medical Center Dr
4TH Floor Clinic B Room 4807
Ann Arbor, MI 48109-4217

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
1594500MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100113000049 MI Practitioner - UrologyPractitioner - General SurgeryPractitioner - Pediatric Medicine 3971644923 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301047893MIMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hamilton Community Health Network Inc. CurrentSince Aug 4, 2022 Accepting new patients
Hamilton Community Health Network, Inc. CurrentSince Jan 16, 2016 Accepting new patients
Hamilton Community Health Network Inc Past Accepting new patients

Locations

225 E 5th St
Ste 300
Flint, MI 48502
Phone (810) 406-4912

2900 N Saginaw St
Flint, MI 48505
Phone (810) 789-9141

Interoperability endpoints

  • Direct secure messaging: david.bloom.1@25862.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/25862/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Genesee County Health Dept.-BurtonBurton, MI, CCN 231886 Federally qualified health center Corporate Director Jan 16, 2006
Hamilton Community Health Network IncFlint, MI, CCN 231806 Federally qualified health center Corporate Director Jul 25, 2022
Hamilton Community Health Network IncClio, MI, CCN 231940 Federally qualified health center Corporate Officer Jan 16, 2016
Hamilton Community Health Network, Inc.Flint, MI, CCN 231128 Federally qualified health center Corporate Officer Jan 16, 2016

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1609967132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "address_2": "4TH FLOOR CLINIC B ROOM 4807",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481094217",
            "telephone_number": "734-936-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "DAVID",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301047893",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301047893",
            "primary": true
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "MI",
            "license": "4301047893",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1594500",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.