Bloom Integrative Wellness Center of South Lake, LLC
NPI 1033831227ActiveOrganization· Nurse Practitioner, Women's Health· Dallas, TX
Nurse Practitioner, Women's Health in Dallas, Texas, registered in NPPES in September 2022. The authorized official on file is Tiffany Reynolds, WHNP, Ceo. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1033831227 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 14, 2022 |
| Last updated in NPPES | Jan 27, 2026 |
| Certified by provider | Jan 27, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Women's Health Primary | 363LW0102X | — | — |
| Clinic/Center, Ambulatory Family Planning Facility | 261QA0005X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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