Kenneth Evan Bloom, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

414 Issued in NC

Practice address

137 Professional Park Dr
Suite C
Mooresville, NC 28117-6540

Phone

(704) 662-8336

Fax

(704) 662-8525

NPI assigned

Sep 21, 2005

Last updated

Aug 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Iredell Memorial Hospital Inc Hospital, Statesville, NC, CCN 340039

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: kennethbloom@phc.allscriptsdirect.net

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.

• Piedmont Healthcare, P.a.

  • Internal Medicine Physician
  • Statesville, NC
  • NPI 1912999897
  Medicare reassignment Care Compare group NPD
• Advanced Foot & Ankle Center, PC

  • Podiatrist
  • Mooresville, NC
  • NPI 1538237474
  Authorized official Same address or phone
• Piedmont Healthcare, PA

  • Durable Medical Equipment & Medical Supplies
  • Statesville, NC
  • NPI 1639041320
  NPD
• Surgery Center on Bluefield LLC

  • Ambulatory Surgical Clinic/Center
  • Mooresville, NC
  • NPI 1841019775
  NPD
• Foot & Ankle Associates PLLC

  • Foot & Ankle Surgery Podiatrist
  • Huntersville, NC
  • NPI 1538155015
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Iredell Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Statesville, NC
  • NPI 1417944224
  Care Compare affiliation

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1811983372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 PROFESSIONAL PARK DR",
            "address_2": "SUITE C",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176540",
            "telephone_number": "704-662-8336",
            "fax_number": "704-662-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 PROFESSIONAL PARK DR",
            "address_2": "SUITE C",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176540",
            "telephone_number": "704-662-8336",
            "fax_number": "704-662-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "KENNETH",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NC",
            "license": "414",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NC",
            "license": "414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790800H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gisela Blake
• Brianna Blankenbicker, RN, IBCLC, ICCE
• Erin Blevins
• Bryan Drew Blitstein, MD
• Blitz Chiropractic PLLC
• Blossom LKN PLLC
• Blue Plastic Surgery Center PLLC
• Martin L Blue, MD
• Olivia Kathleen Bockenstedt
• Robert M Bodajla

• Foot & Ankle Surgery Podiatrist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Foot & Ankle Surgery Podiatrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.