Charles Michael Bloom, Jr., QMHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1651 Centennial Blvd
Springfield, OR 97477-3363

Phone

(541) 726-2467

Fax

(541) 684-4156

NPI assigned

Aug 8, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1699320325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 CHESHIRE AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974025060",
            "telephone_number": "541-684-4100",
            "fax_number": "541-684-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 CENTENNIAL BLVD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773363",
            "telephone_number": "541-726-2467",
            "fax_number": "541-684-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM, JR.",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "credential": "QMHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-08",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serena Star Black, MD
• Lori Blake
• Jane Bland
• Andrea Blattler, FNP
• Cindy Bloom, LMT
• Desirae Bloomquist, NP
• Karen Anne Blundon, PA-C
• Barry Blyton, M.D.
• Benjamin R Bock, PHD
• Gustav Aiden Bock

• All providers in Springfield, OR
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; 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.