Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bloom Primary Mo, LLC

Organization Family Medicine Physician · NPI 1093667750

Bloom Primary Mo, LLC is a Family Medicine Physician in Saint Louis, Missouri. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

540 Maryville Centre Dr Ste 340
Saint Louis, MO 63141-5831
Phone: (720) 923-1250
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1093667750
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Debra Moon-Wadelton — Revenue Cycle Manager · (720) 923-1250
NPI enumeratedFebruary 13, 2026
Last updated in NPPESFebruary 13, 2026
Certification dateFebruary 13, 2026
Mailing address12600 W Colfax Ave Ste B200, Lakewood, CO 80215-3736

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