Jacob Blom, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

103246 Issued in CA

Practice address

4515 Fermi PL Ste 106
Davis, CA 95618-9411

Phone

(530) 750-1955

NPI assigned

Sep 18, 2018

Last updated

Sep 18, 2018By 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 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1841774668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 FERMI PL STE 106",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956189411",
            "telephone_number": "530-750-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 FERMI PL STE 106",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956189411",
            "telephone_number": "530-750-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOM",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabella C Blackman, CNM
• Susan Lynne Blaine, MFT
• Crystal Blankenship, M.D.
• Tennyson Block, MD
• Richard R. Blohm, M.D.
• Mary C Blue, MSCN, RD
• Judith Manheim Blum, MFT
• Barbara Jean Boehler, CNM
• Manuel Bohorquez Jr.
• Lauren Bolnik

• Dentist in Davis, CA
• Providers in Davis, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; 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.