Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

BLOOM PRIMARY MO II, LLC
NPI 1417871013
Internal Medicine in Saint Louis, MO

Active since August 06, 2026
540 MARYVILLE CENTRE DR STE 340, SAINT LOUIS, MO 63141(303) 993-1330 Get Directions Write a Review

NPPES record added: August 6, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Bloom Primary Mo Ii, Llc NPPES

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

BLOOM PRIMARY MO II, LLC (NPI 1417871013) is a healthcare organization registered as an internal medicine in Saint Louis, Missouri and active in the NPI registry since August 2026. The organization lists Debra Kay Moon Wadelton, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1417871013
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBLOOM PRIMARY MO II, LLC
Location Address540 MARYVILLE CENTRE DR STE 340Saint Louis, MO 63141-5831
Mailing Address12600 W Colfax Ave Ste 200Lakewood, CO 80215-3733 · (303) 993-1330
Organization SubpartNo
Authorized OfficialDebra Kay Moon WadeltonAuthorized Official · (720) 923-1250
Enumeration DateAugust 6, 2026
NPPES CertifiedAugust 6, 2026
NPI 1417871013 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
540 MARYVILLE CENTRE DR STE 340, Saint Louis, MO 63141

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

Other Providers at the Same Location NPPES 2

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

Family Medicine
540 MARYVILLE CENTRE DR STE 340
SAINT LOUIS, MO 63141
Family Medicine
540 MARYVILLE CENTRE DR STE 340
SAINT LOUIS, MO 63141

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 II, LLC's NPI number?

The NPI number for Bloom Primary Mo II, LLC is 1417871013. It was assigned to this organization in the NPPES registry on August 6, 2026.

Where is Bloom Primary Mo II, LLC located?

Bloom Primary Mo II, LLC is located at 540 Maryville Centre Dr Ste 340, Saint Louis, MO 63141. The listed phone number is (303) 993-1330.

What is Bloom Primary Mo II, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Bloom Primary Mo II, LLC was last updated on August 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 days 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.