BLOOM PRIMARY MO, LLC
NPI 1093667750
Family Medicine in Saint Louis, MO
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
Specialties & Licenses
Group Practice 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 Primary Mo, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Bloom Primary Mo, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently 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 Primary Mo, LLC's NPI number?
The NPI number for Bloom Primary Mo, LLC is 1093667750. It was assigned to this organization in the NPPES registry on February 13, 2026.
Where is Bloom Primary Mo, LLC located?
Bloom Primary Mo, LLC is located at 540 Maryville Centre Dr Ste 340, Saint Louis, MO 63141. The listed phone number is (720) 923-1250.
What is Bloom Primary Mo, LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Bloom Primary Mo, LLC enrolled in Medicare?
Yes. Bloom Primary Mo, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Bloom Primary Mo, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Bloom Primary Mo, 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. The largest specialties are Family Practice (3) and Nurse Practitioner (3). Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Bloom Primary Mo, LLC was last updated on February 13, 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 Primary Mo, Llc · NPI 1093667750
Family Medicine organization in Saint Louis, Missouri. Organization record, active in the CMS NPPES registry since February 13, 2026.
## Identity
- **NPI:** 1093667750 (Entity type: Organization)
- **Enumerated:** February 13, 2026
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Debra Moon-Wadelton, REVENUE CYCLE MANAGER
## Practice location
- **Address:** 540 MARYVILLE CENTRE DR STE 340, Saint Louis, MO 63141-5831
- **Phone:** (720) 923-1250
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (3), Nurse Practitioner (3); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 13, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1093667750) · Data from the CMS NPPES public registry.