Brooke Lorraine Blomberg

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

27699 Jefferson Ave
Temecula, CA 92590-2661

Phone

(951) 695-4688

NPI assigned

Oct 2, 2017

Last updated

Oct 2, 2017By 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 2

Addresses

Other names 1

• Brooke Lorraine Conlin Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Loma Linda University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Emergency MedicineGroup PAC ID 8628128196, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • San Bernardino, CA
  • NPI 1639314255
  Medicare reassignment Care Compare group
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment
• Southern California Emergency Medicine

  dba Riverside Urgent Care La Sierra

  • Urgent Care Clinic/Center
  • Riverside, CA
  • NPI 1063191575
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fontana, CA
  • NPI 1689606196
  NPD

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

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506902400000",
    "number": "1811407109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10392 GLEN ROCK CIR",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925572692",
            "telephone_number": "951-903-6931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27699 JEFFERSON AVE",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925902661",
            "telephone_number": "951-695-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOMBERG",
        "first_name": "BROOKE",
        "middle_name": "LORRAINE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-02",
        "last_updated": "2017-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "CA",
            "license": "B2084708",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "CONLIN",
            "middle_name": "LORRAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Blank
• Jeremy Blank, PSY.D.
• Hannah Bledsoe, RBT
• Imani Blevins
• Jessica Marie-Pedroza Blevins, LMFT, ATR
• Joshua Aaron Blosser, DO
• Nichele Louise Blosser, DO
• Blue Horizon Staffing Solutions LLC
• Angie Blum
• Brandyn Fredrick Bobb, MD

• Physician Assistant in Temecula, CA
• Providers in Temecula, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; 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.