Blue Ridge Medical Management Corporation

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

Ballad Health Medical Associates
MSMG Beh HLTH JC a

Practice address

2 Professional Park Dr
Suite 15
Johnson City, TN 37604-6583

Phone

(423) 979-0565

Fax

(423) 979-0569

NPI assigned

Jul 12, 2011

Last updated

Mar 28, 2019By 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

Carl Steven Kilgore

Title

President

Phone

(423) 302-3051

Specialties & licenses 1

Addresses

Other names 3

• Ballad Health Medical Associates Doing business as
• MSMG BEH HLTH JC A Doing business as
• BHMA Behavioral Health EAP JC Other name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1073801072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PROFESSIONAL PARK DR",
            "address_2": "SUITE 15",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046583",
            "telephone_number": "423-979-0565",
            "fax_number": "423-979-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PROFESSIONAL PARK DR",
            "address_2": "SUITE 15",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046583",
            "telephone_number": "423-979-0565",
            "fax_number": "423-979-0569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-12",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-302-3051"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballad Health Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MSMG BEH HLTH JC A",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BHMA Behavioral Health EAP JC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (BHMA Interventional Radiology - Johnson City)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (MSMG Neurosurg JC)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)

• Psychiatry Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychiatry Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; 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.