Gordon R Bloomberg, MD

Primary specialty

Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X

License

R2406 Issued in MO

Practice address

1 Childrens PL
Ste 5S30
Saint Louis, MO 63110-1002

Phone

(314) 454-2694

Fax

(314) 454-2515

NPI assigned

Jul 14, 2006

Last updated

Sep 29, 2026By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1992746903
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1619993920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "C B 8116",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-2694",
            "fax_number": "314-454-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "STE 5S30",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-2694",
            "fax_number": "314-454-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMBERG",
        "first_name": "GORDON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "MO",
            "license": "R2406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1737758",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103810076",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloom Primary Mo II, LLC
• Bloom Primary Mo, LLC
• Bloom Within Counseling, LLC
• Ilene Linda Bloom-Ellis, MSW, LCSW, ACSW
• Michelle Marie Bloom, ACNP
• Maryann L Bloomer, OTR
• Blooming Beyond the Blues LLC
• Blooming Oaks Wellness & Rehabilitation LLC (Bluebird Wellness & Rehabilitation)
• Harold Raymond Bloss, ED.D.
• Jacque Blossfield, LPC

• Pediatric Allergy/Immunology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatric Allergy/Immunology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.