Look up the most recent NPI and PECOS records

Joseph David Bloom

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

Based on the most recent information from CMS, provider Joseph David Bloom does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1548390776
Provider Type
Individual
Full Name
Bloom, Joseph David
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
3/6/2007
Last Updated
7/8/2007

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-6176

Unlisted Fax

Mailing Location

416 NW 13th Ave Apt 404, Portland, OR 97209-2938

(503) 973-5156

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License MD10455 Oregon

Provider Identifiers

ID	Description	Issuer
ID 257220	Description Medicaid	Issuer Unlisted Oregon

Joseph David Bloom

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Hipshman, Lawrence

Rodriguez, Mikaela Lea

Boehnlein, James Kevin

Boverman, Joshua Findley

Cheng, Keith Y. M.

Passmore, Thomas Albert

Rosen, Donald Edward

Lewy, Alfred James

Gramann, Stacey

Laporte, Justin