Dr Douglas Randal Bloom, PHD is a medicare enrolled "Clinical Neuropsychologist" provider in Houston, Texas. His current practice location is
6621 Fannin St, Ccc 1630.00, Houston, Texas. You can reach out to his office (for appointments etc.) via phone at
(832) 822-3700.
Dr Douglas Randal Bloom is licensed to practice in Texas (license number 25782) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1417001116.
Healthcare Provider's Profile
| Full Name | Dr Douglas Randal Bloom |
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| Gender | Male |
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| Speciality | Clinical Neuropsychologist |
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| Location | 6621 Fannin St, Houston, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1417001116
- Provider Enumeration Date: 01/22/2007
- Last Update Date: 01/10/2023
Medicare PECOS Information:
- PECOS PAC ID: 9335295948
- Enrollment ID: I20090923000663
Medical Identifiers
Medical identifiers for Dr Douglas Randal Bloom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417001116 | NPI | - | NPPES |
| 1027542-03 | Medicaid | TX | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103T00000X | Psychologist | 25782 (Texas) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 25782 (Texas) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Douglas Randal Bloom allows following entities to bill medicare on his behalf.
| Entity Name | Texas Childrens Physician Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1861675506
PECOS PAC ID: 4385722081
Enrollment ID: O20080422000209 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Douglas Randal Bloom is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Douglas Randal Bloom, PHD
6621 Fannin St, Ccc 1630.00,
Houston, TX 77030-2303
Ph: (832) 822-3700 | Dr Douglas Randal Bloom, PHD
6621 Fannin St, Ccc 1630.00,
Houston, TX 77030-2303
Ph: (832) 822-3700 |
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