Melissa M Bloom, M.D.
Individual provider Active NPI Family Medicine Physician · Honolulu, HI
NPI 1689775173 · NPPES record last updated Aug 8, 2016
Key facts
- NPI
- 1689775173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD13104 (HI)
- Practice address
- 1314 S King St
Suite 514
Honolulu, HI 96814-1956 - Phone
- (808) 591-8611
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD13104 | HI | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD13104 | HI | Yes |
Addresses
Primary practice location
1314 S King St
Suite 514
Honolulu, HI 96814-1956
Mailing address
1314 S King St
Suite 514
Honolulu, HI 96814-1956
Phone (808) 591-8611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57549102 | Medicaid | HI |
Other names
- Dr. Melissa M Lee
Other providers in Honolulu, HI
- Jacob Wiley Blickenstaff
- Jacob Samuel Blitstein
- Janci Blodgett
- Karen Kae Blonigan
- Joseph Robert Bloom
- Toni M Bloom
- Blooming Minds Wellness Nook
- Blue Ocean Psychiatry LLC
- Blue Wave Medical Billing
- Tanecia Marshia Blue
All providers in Honolulu, HI · Family Medicine Physician in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.