Blue Ridge Concierge Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLUE RIDGE CONCIERGE MEDICINE LLC

Practice address

101 Riverstone Vis Ste 203
Blue Ridge, GA 30513-6668

Phone

(706) 946-4240

NPI assigned

Dec 23, 2020

Last updated

Dec 23, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raymond Tidman, MDNPI 1588663686

Title

President

Phone

(706) 946-4240

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Raymond Eugene Tidman, MD

  • Family Medicine Physician
  • Blue Ridge, GA
  • NPI 1588663686
  Medicare reassignment Care Compare group NPD Authorized official
• Lee Ann Tidman, CNP

  • Nurse Practitioner
  • Blue Ridge, GA
  • NPI 1316947260
  Medicare reassignment Care Compare group NPD
• Paula Watkins Millhouse, APRN, FNP-BC

  • Family Nurse Practitioner
  • Blue Ridge, GA
  • NPI 1467431502
  NPD (past)
• Lindsey Panter Niknezhad, PA-C

  • Medical Physician Assistant
  • Blue Ridge, GA
  • NPI 1194272542
  NPD (past)
• Shannon Lawrence Pitman, M.D.

  • Family Medicine Physician
  • Blue Ridge, GA
  • NPI 1982773891
  NPD (past)
• Frank Stanson Trigg, M.D.

  • Internal Medicine Physician
  • Blue Ridge, GA
  • NPI 1174522262
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608681600000",
    "number": "1013504174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RIVERSTONE VIS STE 203",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305136668",
            "telephone_number": "706-946-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 RIVERSTONE VIS STE 203",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305136668",
            "telephone_number": "706-946-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE CONCIERGE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A",
        "authorized_official_last_name": "TIDMAN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-946-4240",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "32826",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joann Belmont, RN
• Paul Nelson Blais, DC
• Kara Brynn Blake, RBT
• Blue Ridge Anesthesia Associates, Inc
• Blue Ridge Chiropractic and Life Center
• Blue Ridge Dermatology
• Blue Ridge Dermatology
• Blue Ridge Georgia Hospital Company LLC (Blue Ridge Rural Health Clinic)
• Blue Ridge Georgia Hospital Company LLC (Fannin Regional Hospital)
• Blue Ridge Georgia Hospital Company LLC (Blue Ridge Medical Center)

• Family Medicine Physician in Blue Ridge, GA
• Providers in Blue Ridge, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.