Bloom Primary Mo, LLC
NPI 1093667750ActiveOrganization· Family Medicine· Saint Louis, MO
Family Medicine in Saint Louis, Missouri, registered in NPPES in February 2026. The authorized official on file is Debra Kay Moon-Wadelton, MOON-WADELTON, Revenue Cycle Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1093667750 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 13, 2026 |
| Last updated in NPPES | Feb 13, 2026 |
| Certified by provider | Feb 13, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
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 (MO) |
|---|
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