Blooming Medical Group, PLLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

BLOOMING MEDICAL GROUP, PLLC

Practice address

964 High House Rd Unit 4037
Cary, NC 27513-3574

Phone

(910) 644-0887

NPI assigned

Dec 21, 2021

Organization subpart

No

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

Authorized official

Name

Emily Becker Pevtsov, PANPI 1679977391

Title

Owner

Phone

(910) 644-0887

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Emily Becker Pevtsov, PA-C

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1679977391
  Medicare reassignment Care Compare group Authorized official
• Gretchen Barnes, PA-C

  • Physician Assistant
  • Charlotte, NC
  • NPI 1598353427
  Medicare reassignment Care Compare group
• Joseph Vincent Jordan, PA-C

  • Physician Assistant
  • Raleigh, NC
  • NPI 1467082743
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1750041497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 HIGH HOUSE RD UNIT 4037",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275133574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 HIGH HOUSE RD UNIT 4037",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275133574",
            "telephone_number": "910-644-0887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMING MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2023-01-31",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "PEVTSOV",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "BECKER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-644-0887",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00414600",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacie Bliss, LPC
• Blizzard Health Services
• Jessica Lynn Block, MA, NCC, LPCA, LCASA
• Carie L Bloom, MD
• O Josh Bloom, MD
• Valerie Blouin-Hunter
• James Gordon Blount, MD
• Blue Ridge Behavioral Health & Trauma Recovery PLLC
• Michael Blum
• Susan Hyman Blumenthal, PA

• Physician Assistant in Cary, NC
• Providers in Cary, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.