BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC
NPI 1033831227
Nurse Practitioner - Women's Health in Dallas, TX
About Bloom Integrative Wellness Center Of South Lake, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLOOM INTEGRATIVE WELLNESS CENTER OF SOUTH LAKE, LLC (NPI 1033831227), doing business as Bloom Integrative Wellness Center, is a healthcare organization registered as a women's health in Dallas, Texas and active in the NPI registry since September 2022. The organization holds a CLIA Microscopy certificate valid through July 23, 2027 and lists Tiffany Reynolds, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Bloom Integrative Wellness Center Of South Lake, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Bloom Integrative Wellness Center Of South Lake, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D2286076
Bloom Integrative Wellness Center · Dallas, TXFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Bloom Integrative Wellness Center Of South Lake, LLC's NPI number?
The NPI number for Bloom Integrative Wellness Center Of South Lake, LLC is 1033831227. It was assigned to this organization in the NPPES registry on September 14, 2022. The provider is doing business as Bloom Integrative Wellness Center.
Where is Bloom Integrative Wellness Center Of South Lake, LLC located?
Bloom Integrative Wellness Center Of South Lake, LLC is located at 14114 Dallas Pkwy Ste 310, Dallas, TX 75254. The listed phone number is (844) 864-8928.
What is Bloom Integrative Wellness Center Of South Lake, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.
Is Bloom Integrative Wellness Center Of South Lake, LLC enrolled in Medicare?
Yes. Bloom Integrative Wellness Center Of South Lake, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Bloom Integrative Wellness Center Of South Lake, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Bloom Integrative Wellness Center Of South Lake, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Bloom Integrative Wellness Center Of South Lake, LLC hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D2286076) is associated with this NPI, valid through July 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Bloom Integrative Wellness Center Of South Lake, LLC was last updated on January 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Bloom Integrative Wellness Center Of South Lake, Llc · NPI 1033831227
Women's Health organization in Dallas, Texas. Organization record, active in the CMS NPPES registry since September 14, 2022.
## Identity
- **NPI:** 1033831227 (Entity type: Organization)
- **Enumerated:** September 14, 2022
- **Primary specialty:** Nurse Practitioner - Women's Health · taxonomy 363LW0102X
- **Also known as:** Bloom Integrative Wellness Center (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Tiffany Reynolds, CEO
## Practice location
- **Address:** 14114 DALLAS PKWY STE 310, Dallas, TX 75254-1315
- **Phone:** (844) 864-8928
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 27, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1033831227) · Data from the CMS NPPES public registry.