NPI Code Detail JSON Logo

1467394874 NPI number — BLOOM MEDICAL GROUP CA PC

NPI Number: 1467394874
Health Care Provider/Practitioner: BLOOM MEDICAL GROUP CA PC

Information about “1467394874” NPI (BLOOM MEDICAL GROUP CA PC) exists in 1467394874 in HTML format HTML  |  1467394874 in plain Text format TXT  |  1467394874 in PDF (Portable Document Format) PDF  |  1467394874 in an XML format XML  formats.

NPI Number : 1467394874 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467394874",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BLOOM MEDICAL GROUP CA PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8 CAMPUS DR STE 105",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PARSIPPANY",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07054-4409",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "551-293-6969",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "284 W SHAW AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLOVIS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93612-3601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "551-293-6969",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/06/2026",
    "LastUpdateDate": "04/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SALAS",
    "AuthorizedOfficialFirstName": "GABRIEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "551-293-6969",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WC3500X",
          "TaxonomyName": "Cardiac Rehabilitation Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "364SR0400X",
          "TaxonomyName": "Rehabilitation Clinical Nurse Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RP1001X",
          "TaxonomyName": "Pulmonary Disease Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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