Kelsey L. Bloom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW20216 Issued in FL

Practice address

30 Ardisia LN
Saint Johns, FL 32259-3881

Phone

(904) 376-3800

Fax

(904) 390-7458

NPI assigned

Dec 28, 2022

Last updated

Jan 25, 2024By the provider in NPPES

Sex

Female

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Baptist Behavioral Health LLCGroup PAC ID 7315166394, 120 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.95 of 100Reported as group

Quality

84.69

Promoting interoperability

100

Improvement activities

40

Cost

74.91

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Baptist Behavioral Health, LLC

  • Professional Counselor
  • Jacksonville, FL
  • NPI 1215906649
  Medicare reassignment Care Compare group NPD
• Southern Baptist Hospital of Florida Inc

  dba Baptist Home Health Care

  • Home Health Agency
  • Jacksonville, FL
  • NPI 1841351632
  NPD (past)

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

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1730892365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748519",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748519",
            "telephone_number": "904-376-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ARDISIA LN",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322593881",
            "telephone_number": "904-376-3800",
            "fax_number": "904-390-7458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "KELSEY",
        "middle_name": "L.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-28",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW20216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henry Donald Benson Jr., PHD
• Vanessa M. Berrios, PA-C
• Better Families Counseling, PLLC
• BJ's Wholesale Club Inc.
• Black Canary Therapy LLC (Lifeologie Counseling St Johns)
• Peyton Lightning Bolt
• Joseph William Bonura, DPM
• Margaret Suzanne Booher
• Allison Borhani
• Tracie Boudreau

• Clinical Social Worker in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.