DR. STANLEY WAYNE BLOM PH.D.
NPI 1538119912
Psychologist - Clinical in South Bend, IN
NPI Status: Active since May 10, 2006
Contact Information
150 W ANGELA BLVD
SOUTH BEND, IN
ZIP 46617
Phone: (574) 251-1286
Fax: (574) 232-5386
- Individual
- Male
- Psychologist
- Clinical
- PECOS Enrolled
- Opted-Out Medicare
About STANLEY BLOM
This page provides the complete NPI Profile along with additional information for Stanley Blom, a provider established in South Bend, Indiana with a medical specialization in Psychologist, focusing in clinical . The healthcare provider is registered in the NPI registry with number 1538119912 assigned on May 2006. The practitioner's primary taxonomy code is 103TC0700X with license number 20040666A (IN). The provider is registered as an individual and his NPI record was last updated 6 years ago.
- NPI
- 1538119912
- Provider Name
- DR. STANLEY WAYNE BLOM PH.D.
- Other Name
- STAN BLOM, PH.D., INC PH.D.
- Other Name Type
- Other Name (5)
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 150 W ANGELA BLVD SOUTH BEND, IN 46617
- Location Phone
- (574) 251-1286
- Location Fax
- (574) 232-5386
- Mailing Address
- 150 W ANGELA BLVD SOUTH BEND, IN 46617
- Mailing Phone
- (574) 251-1286
- Mailing Fax
- (574) 232-5386
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 05-10-2006
- Last Update Date
- 08-12-2019
- Code Navigator
A clinical psychologist like Stanley Blom assesses, diagnoses, and treats mental, emotional, and behavioral disorders. Clinical psychologists help people deal with problems ranging from short-term personal issues to severe, chronic conditions. Clinical psychologists interview patients, give diagnostic tests, provide psychotherapy and design behavior modification programs to help patients.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Stanley Blom opted out of Medicare effective on 11-01-2019 until 11-01-2025. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychologist Clinical
- Taxonomy Code
- 103TC0700X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 20040666A
- License State
- IN
- Taxonomy Description
- A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 200008720 | MEDICAID (05) | IN |
Medicare Participation & PECOS Enrollment Status
Stanley Blom is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 11-01-2019
Opt-Out End Date: 11-01-2025
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: No
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 46617 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99205
- Average New Patient Price $161.76
- Minimum New Patient Price $53.07
- Maximum New Patient Price $161.76
- Average New Patient Copayment $40.44
- Minimum New Patient Copayment $13.26
- Maximum New Patient Copayment $40.44
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $94.22
- Minimum Established Patient Price $16.93
- Maximum Established Patient Price $132.22
- Average Established Patient Copayment $23.55
- Minimum Established Patient Copayment $4.23
- Maximum Established Patient Copayment $33.05
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 5 | 3 | 8 | 1 | 1 | 9 | 9 | 1 | 2 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 6 | 8 | 2 | 1 | 18 | 9 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 6 + 8 + 2 + 1 + 1 + 8 + 9 + 2 + 24 = 68 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 68 = 2 | 2 | ||||||||
The NPI number 1538119912 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 12 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1992749709 | KENT A HERSHBERGER HSPP Individual | Psychologist (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 220-4968 |
| 1871512939 | MR. FRANCIS G SAMORA LCSW Individual | Social Worker (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5065 |
| 1891882510 | DR. TIMOTHY ALLAN ONKKA PH.D. Individual | Psychologist (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5237 |
| 1033298880 | DR. JAMES P SCHALLIOL I MD Individual | Psychiatry & Neurology (Psychiatry) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5237 |
| 1548454390 | JAMIE REXINE PRICE M.A., L.M.H.C. Individual | Counselor | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5065 |
| 1356520977 | TIMOTHY A. ONKKA, PH.D., P.C. Organization | Psychologist (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5237 |
| 1720250756 | ADVANCED MEDICAL COMPUTING INC Organization | Social Worker (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5065 |
| 1730463001 | BARBARA FINLEY, LCSW/M.DIV,. LLC Organization | Social Worker (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5065 |
| 1245237114 | MRS. GWENDOLYN C DEHORN L.C.S.W Individual | Social Worker (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 245-3920 |
| 1124094727 | BARBARA A FINLEY LCSW Individual | Social Worker (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5065 |
| 1760613681 | LISA J DULCET MSW, LCSW Individual | Social Worker (Clinical) | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 232-5065 |
| 1356909758 | KAITLYN KURZHAL M.A. CCC-SLP Individual | Speech-Language Pathologist | 150 W ANGELA BLVD SOUTH BEND, IN 46617 (574) 213-5080 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1538119912, enumerated in the NPI registry as an "individual" on May 10, 2006
The provider is located at 150 W Angela Blvd South Bend, In 46617 and the phone number is (574) 251-1286
The provider's speciality is Psychologist with taxonomy code 103TC0700X with a focus in Clinical
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
Medicare beneficiaries should expect a typical cost of $161.76 with an average copayment of $40.44 for new patient appointments. Established patients should expect a typical charge of $94.22 and an average copayment of 23.55. Please review your insurance plan or contact the provider directly to determine your specific costs.
No, the provider signed an affidavit on November 01, 2019 to opt-out of the Medicare program. The provider is excluded from the Medicare program until November 01, 2025.
This NPI record was last updated on May 10, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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