Bloom Primary Tx, PLLC
NPI 1275901340ActiveOrganization· Family Medicine· Southlake, TX
Family Medicine in Southlake, Texas, registered in NPPES in September 2015. The authorized official on file is Debra Kay Moon Wadelton, Authorized Official. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1275901340 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 8, 2015 |
| Last updated in NPPES | Sep 21, 2026 |
| Certified by provider | Sep 21, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | P2012 | TX |
| Nurse Practitioner, Family | 363LF0000X | 617313 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 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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