NPIMap

Organization Active NPI

Bloom Physician Housecalls PA

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1770322299
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLOOM PHYSICIAN HOUSECALLS PA
Practice address
8000 W Ih 10 Ste 201
San Antonio, TX 78230-3879
Phone
(303) 993-1330
NPI assigned
May 23, 2024
Last updated
May 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Authorized official

Name
Debra Moon Wadelton
Title
Authorized Official
Phone
(720) 923-1250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

8000 W Ih 10 Ste 201
San Antonio, TX 78230-3879

Mailing address

PO Box 17112
Denver, CO 80217-0112
Phone (720) 923-1250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240626000480 TX Part B Supplier - Clinic/Group Practice 9032653563 Receives reassigned benefits from 12 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

8000 W Interstate 10
San Antonio, TX 78230

8000 W Interstate 10
Ste 240
San Antonio, TX 78230
Phone (210) 903-0000

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1770322299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17112",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802170112",
            "telephone_number": "720-923-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 W IH 10 STE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782303879",
            "telephone_number": "303-993-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM PHYSICIAN HOUSECALLS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "MOON WADELTON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "720-923-1250"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; 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.