MEDICARE: DR. STEPHEN A BLOOM M.D.

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	207RC0000X	Cardiovascular Disease Physician	329171	LA
2	207RC0000X	Cardiovascular Disease Physician	R6G52	MO
3	207RC0000X	Cardiovascular Disease Physician	0421697	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00475776	OTHER	MO	RAILROAD MEDICARE
2	K676856	OTHER	MO	ENCOMPASS MEDICARE NUMBER
3	K67A00045	OTHER	KS	ENCOMPASS MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972552552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN A BLOOM M.D.

Provider Business Mailing Address
First Line	:	5100 W 110TH ST STE 200
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1215
Country	:	US
Telephone Number	:	913-253-3000
Fax Number	:	913-663-2980

Provider Business Practice Location Address
First Line	:	5100 W 110TH ST STE 200
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1215
Country	:	US
Telephone Number	:	913-253-3000
Fax Number	:	913-663-2980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	01/24/2022

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Directions to “ DR. STEPHEN A BLOOM M.D.” Practice Location

Language	Start Address	Practice Location

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