Michael Gary Bloom, MD

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

A23832 Issued in CA

Practice address

15243 Van Owen St #403
Van Nuys, CA 91405

Phone

(818) 988-8800

Fax

(818) 988-3416

NPI assigned

Sep 21, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1821197591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15243 VAN OWEN ST #403",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "91405",
            "telephone_number": "818-988-8800",
            "fax_number": "818-988-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15243 VAN OWEN ST #403",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "91405",
            "telephone_number": "818-988-8800",
            "fax_number": "818-988-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "MICHAEL",
        "middle_name": "GARY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CA",
            "license": "A23832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A238320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bliss Home Health Agency
• Bliss Home Health, Inc.
• Bliss Hospice, Inc.
• Blissful Healthcare Services, Inc.
• Bloom Home Health, Inc
• Zara Bloom
• Bloomfield Enterprises LLC (Pinnacle Mobility)
• Jason Michael Bloomfield, ATP
• Blooming Children
• Blooming Garden Hospice Care

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.