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DR. ELLIS JEREMY BLOOM DO
NPI 1124875059
Student in an Organized Health Care Education/Training Program in Providence, RI

Active since April 30, 2024PECOS Enrolled
593 EDDY ST, PROVIDENCE, RI 02903(401) 793-2695(401) 444-4165 Get Directions Write a Review

NPPES record last updated: April 30, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Ellis Jeremy Bloom Do NPPES

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

DR. ELLIS JEREMY BLOOM DO (NPI 1124875059) is an individual student in an organized health care education/training program in Providence, Rhode Island, licensed in Rhode Island (LP06198) and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124875059
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. ELLIS JEREMY BLOOMCredential: DO
Location Address593 EDDY STProvidence, RI 02903-4923
Mailing Address593 Eddy StProvidence, RI 02903-4923 · (401) 793-2695 · Fax (401) 444-4165
Phone(401) 793-2695
Fax(401) 444-4165
Sole ProprietorNo
Enumeration DateApril 30, 2024
NPPES CertifiedApril 30, 2024
✔ NPI 1124875059 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in RI · LP06198
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
593 EDDY ST, Providence, RI 02903
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Ellis Jeremy Bloom Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KEITH-AUSTIN SCARFO D.O.
Anesthesiology
593 EDDY ST, APC 6
PROVIDENCE, RI 02903
Providence County (401) 444-3777
AILEEN HSUEH
Surgery
593 EDDY ST
PROVIDENCE, RI 02903
Providence County (401) 444-8450
RHODE ISLAND HOSPITAL
General Acute Care Hospital
593 EDDY ST, MAIN 4
PROVIDENCE, RI 02903
Providence County (401) 444-7585
DR. GA HIE NAM M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
593 EDDY ST
PROVIDENCE, RI 02903
Providence County (401) 444-5057
EUGENIE ATALLAH
Psychiatry & Neurology (Neurology)
593 EDDY ST
PROVIDENCE, RI 02903
Providence County (401) 606-2645
BRIAN CAO MD
Student in an Organized Health Care Education/Training Program
593 EDDY ST
PROVIDENCE, RI 02903
Providence County (401) 606-4286
BRET CAULFIELD
Physician Assistant
593 EDDY ST
PROVIDENCE, RI 02903
Providence County (401) 444-4000
JUNG HO GONG
Student in an Organized Health Care Education/Training Program
593 EDDY ST
PROVIDENCE, RI 02903
Providence County (401) 793-2695

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 Ellis Bloom's NPI number?

The NPI number for Ellis Bloom is 1124875059. It was assigned to this individual provider in the NPPES registry on April 30, 2024.

Where is Ellis Bloom located?

Ellis Bloom practices at 593 Eddy St, Providence, RI 02903. The listed phone number is (401) 793-2695.

What is Ellis Bloom's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ellis Bloom enrolled in Medicare?

Yes. Ellis Bloom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ellis Bloom was last updated on April 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.