Provider Demographics
NPI:1972552552
Name:BLOOM, STEPHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W 110TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1215
Mailing Address - Country:US
Mailing Address - Phone:913-253-3000
Mailing Address - Fax:913-663-2980
Practice Address - Street 1:5100 W 110TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1215
Practice Address - Country:US
Practice Address - Phone:913-253-3000
Practice Address - Fax:913-663-2980
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA329171207RC0000X
MOR6G52207RC0000X
KS0421697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00475776OtherRAILROAD MEDICARE
MOK676856OtherENCOMPASS MEDICARE NUMBER
KSK67A00045OtherENCOMPASS MEDICARE NUMBER
KS100205960AMedicaid
MO202401410Medicaid
KS4506856DMedicare ID - Type UnspecifiedKANAS MEDICARE #
MOK676856Medicare PIN
MOMA2311001Medicare PIN
KSKA1701001Medicare PIN
MOP00475776OtherRAILROAD MEDICARE
KS100205960AMedicaid
MOK676856OtherENCOMPASS MEDICARE NUMBER
KSK676856AMedicare PIN