Alisa Carole Bloom, MPH, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164-004502

Practice address

1020 Milwaukee Ave
Suite 341
Deerfield, IL 60015-3513

Phone

(773) 951-5557

Fax

(847) 941-0559

NPI assigned

Nov 2, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Alisa Levine Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1992005326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 MILWAUKEE AVE",
            "address_2": "SUITE 341",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153513",
            "telephone_number": "773-951-5557",
            "fax_number": "847-941-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MILWAUKEE AVE",
            "address_2": "SUITE 341",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153513",
            "telephone_number": "773-951-5557",
            "fax_number": "847-941-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "ALISA",
        "middle_name": "CAROLE",
        "credential": "MPH, RDN, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-02",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "164-004502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISA",
            "last_name": "LEVINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christine M Bernacki
• Jessica Lee Bernheim, PHARMD
• Cathy J Betti, LMFT
• Joylynn Leanne Blasing
• Robert Mark Blazekovich, DDS
• Bruce Bloom, DDS,JD
• Jessica Bloom, M.A.
• Marc H Boff, ATC, PT, DPT, CSCS
• Chad Bolman, RBT
• Bond Drug Company of Illinois LLC

• All providers in Deerfield, IL
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.