| Bloom Primary Mo, LLC | |
|
540 Maryville Centre Dr Ste 340 Saint Louis MO 63141-5831 | |
| (720) 923-1250 | |
| Not Available |
| Full Name | Bloom Primary Mo, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 540 Maryville Centre Dr Ste 340, Saint Louis, Missouri |
| Authorized Official Name and Position | Debra Kay Moon-wadelton (REVENUE CYCLE MANAGER) |
| Authorized Official Contact | 7209231250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Primary Mo, LLC 12600 W Colfax Ave Ste B200 Lakewood CO 80215-3736 Ph: (720) 923-1250 | Bloom Primary Mo, LLC 540 Maryville Centre Dr Ste 340 Saint Louis MO 63141-5831 Ph: (720) 923-1250 |
| NPI Number | 1093667750 |
|---|---|
| Provider Enumeration Date | 02/13/2026 |
| Last Update Date | 02/13/2026 |
| Certification Date | 02/13/2026 |
| Medicare PECOS PAC ID | 2062997638 |
|---|---|
| Medicare Enrollment ID | O20260401000355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093667750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Christopher M Compton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174567176 PECOS PAC ID: 9234139874 Enrollment ID: I20070105000185 |
| Provider Name | Lubbna Johar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578761706 PECOS PAC ID: 2365599461 Enrollment ID: I20100423000902 |
| Provider Name | Phylicia D Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053782276 PECOS PAC ID: 0941598197 Enrollment ID: I20161004001729 |
| Provider Name | Sarah Ann Sotta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164913141 PECOS PAC ID: 9830446491 Enrollment ID: I20180727001766 |
| Provider Name | Molly Page Lashley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417504358 PECOS PAC ID: 0840621710 Enrollment ID: I20200508000754 |
| Provider Name | Danielle Ann Whitacre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134316540 PECOS PAC ID: 7517003601 Enrollment ID: I20260415000424 |
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