Active NPI
Justin Russell Bloomer
- Behavior Analyst
- Winchester, VA
National Provider Identifier
1730785452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 120 Bellview Ave
Winchester, VA 22601-3142 - Phone
- (540) 542-0200
- NPI assigned
- Dec 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
120 Bellview Ave
Winchester, VA 22601-3142
Mailing address
110 Peggy CT
Bunker Hill, WV 25413-3731
Phone (304) 671-4733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1730785452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 PEGGY CT",
"city": "BUNKER HILL",
"state": "WV",
"postal_code": "254133731",
"telephone_number": "304-671-4733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 BELLVIEW AVE",
"city": "WINCHESTER",
"state": "VA",
"postal_code": "226013142",
"telephone_number": "540-542-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOMER",
"first_name": "JUSTIN",
"middle_name": "RUSSELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-08",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winchester, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.