MEDICARE: BLOOM PEDIATRICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	363LP0200X	Pediatric Nurse Practitioner

General Provider Information

NPI Number	:	1801732870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	735 E 129TH PL S
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-3722
Country	:	US
Telephone Number	:	918-629-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	10124 S SHERIDAN RD STE A
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-6742
Country	:	US
Telephone Number	:	918-629-7233
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	JENNIFER SASSIN
Credential	:	APRN
Telephone Number	:	918-395-5707

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	05/19/2026

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