ERNEST RANDY BLOOM, PTA — NPI 1366561011 (Licensed & Credentialed Physical Therapy Assistant in AUGUSTA, GA)

CMS-1500 Box 24J / 33a • NPI

1366561011

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

225200000X

Licensed & Credentialed Physical Therapy Assistant

Box 32 Service Location & ZIP+4

1930 HIGHLAND AVENUE SUITE A, AUGUSTA, GA, 30904-7803

✓ 9-Digit EDI 837 ZIP+4 (30904-7803)

Practice Phone & Referral Fax

(706) 481-9105

Fax: (706) 481-9107

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1366561011 (ERNEST RANDY BLOOM, PTA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1366561011` (NPI-1 Individual Practitioner)
Provider / Legal Name	ERNEST RANDY BLOOM, PTA
Plain-English Specialty	Licensed & Credentialed Physical Therapy Assistant NUCC Code: `225200000X` (Physical Therapy Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1930 HIGHLAND AVENUE SUITE A, AUGUSTA, GA, 30904-7803
Practice Telephone / Fax	Tel: (706) 481-9105 \| Fax: (706) 481-9107
Administrative Mailing Address	1930 HIGHLAND AVE STE A, AUGUSTA, GA, 30904-7803
Enumeration & Last Sync	Enumerated: 2007-03-27 \| CMS Record Updated: 2022-07-21

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1930 HIGHLAND AVENUE SUITE A, AUGUSTA, GA, 30904-7803

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Plain-English Taxonomy & CMS Crosswalk (225200000X)

What Does Taxonomy Code 225200000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225200000X translates to:
"Licensed & Credentialed Physical Therapy Assistant"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapy Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ERNEST RANDY BLOOM, PTA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225200000X` — Physical Therapy Assistant Plain English: Licensed & Credentialed Physical Therapy Assistant	State: PA \| License: `TE007060` \| Primary: Secondary
`225200000X` — Physical Therapy Assistant Plain English: Licensed & Credentialed Physical Therapy Assistant	State: GA \| License: `PTA002060` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ERNEST RANDY BLOOM, PTA (NPI #1366561011)