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BLOOM PRIMARY MO, LLC
NPI 1093667750
Family Medicine in Saint Louis, MO

Active since February 13, 2026
540 MARYVILLE CENTRE DR STE 340, SAINT LOUIS, MO 63141(720) 923-1250 Get Directions Write a Review

NPPES record last updated: February 13, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Bloom Primary Mo, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLOOM PRIMARY MO, LLC (NPI 1093667750) is a healthcare organization registered as a family medicine in Saint Louis, Missouri and active in the NPI registry since February 2026. The organization lists Debra Kay Moon-wadelton, Revenue Cycle Manager, as its authorized official.

NPPES Registry Identity

NPI1093667750
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBLOOM PRIMARY MO, LLC
Location Address540 MARYVILLE CENTRE DR STE 340Saint Louis, MO 63141-5831
Mailing Address12600 W Colfax Ave Ste B200Lakewood, CO 80215-3736 · (720) 923-1250
Phone(720) 923-1250
Organization SubpartNo
Authorized OfficialDebra Kay Moon-wadeltonRevenue Cycle Manager · (720) 923-1250
Enumeration DateFebruary 13, 2026
NPPES CertifiedFebruary 13, 2026
✔ NPI 1093667750 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

540 MARYVILLE CENTRE DR STE 340, Saint Louis, MO 63141
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions

What is BLOOM PRIMARY MO, LLC's NPI number?

The NPI number assigned to this healthcare provider is 1093667750, enumerated as an "organization" on February 13, 2026.

Where is the provider located?

The provider is located at 540 MARYVILLE CENTRE DR STE 340 SAINT LOUIS, MO 63141 and the phone number is (720) 923-1250.

What is the provider's specialty?

Family Medicine with taxonomy code 207Q00000X.