NPIMap

Individual provider Active NPI

Jordan Bloom, RN, BSN, APRN, CRNA

  • Certified Registered Nurse Anesthetist
  • Forest Lake, MN
National Provider Identifier
1851996581
Registry record updated Sep 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
30535 Issued in TN
Practice address
6362 207TH St N
Forest Lake, MN 55025-8022
Phone
(763) 777-0925
NPI assigned
Dec 1, 2020
Last updated
Sep 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 30535 TN Primary

Addresses

Primary practice location

6362 207TH St N
Forest Lake, MN 55025-8022

Mailing address

6643 N Hamilton Cir
Olive Branch, MS 38654-7150
Phone (763) 777-0925

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL jmbloo@smumn.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20211026000152 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173911120 Reassigns benefits to 1 organization
I20230824004260 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173911120 Reassigns benefits to 1 organization
I20241211002328 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173911120 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (651) 262-7633

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
3062MNMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Mississippi LLC CurrentSince May 11, 2023 Accepting new patients
Allina Health System CurrentSince Jan 27, 2025 Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Oct 18, 2021 Accepting new patients
Allina Health System Current Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Dec 6, 2024 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Oct 18, 2021 Accepting new patients
Allina Health System CurrentSince Jan 27, 2025 Accepting new patients

Locations

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

7601 Southcrest Pkwy
Southaven, MS 38671
Phone (662) 349-4000

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

1500 W Poplar Ave
Collierville, TN 38017
Phone (901) 227-8140

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

6225 Humphreys Blvd
Memphis, TN 38120
Phone (901) 227-2727

Organizations & group practices 7

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.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1851996581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6643 N HAMILTON CIR",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547150",
            "telephone_number": "763-777-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6362 207TH ST N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550258022",
            "telephone_number": "763-777-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "JORDAN",
        "credential": "RN, BSN, APRN, CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-01",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "30535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jmbloo@smumn.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6362 207th St N",
            "city": "Forest Lake",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550258022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Forest Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.