Bloom Primary TX II, PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLOOM PRIMARY TX II, PA

Practice address

545 S Nolen Dr Ste 300
Southlake, TX 76092-9176

Phone

(303) 993-1330

NPI assigned

Aug 6, 2026

Organization subpart

No

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

Authorized official

Name

Debra Moon Wadelton

Title

Authorized Official

Phone

(720) 923-1250

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1785974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1689598377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12600 W COLFAX AVE STE 200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802153733",
            "telephone_number": "303-993-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 S NOLEN DR STE 300",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929176",
            "telephone_number": "303-993-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PRIMARY TX II, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-06",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "MOON WADELTON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "720-923-1250"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Michelle Bisbey, MPT, PT
• Lisa Bishop, OD
• Jeff Black, MA, LPC
• Jeanne Marie Blakeslee, PMHNP
• Angelica Bledsoe, RBT
• Blue Ocean Health Services LLC
• Blue Ridge Medical Solutions LLC
• Ashley Bobb
• Bobbye Records LLC
• Michael A Bogdan, MD, FACS

• Internal Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.