Blue Ridge Medical Management Corporation
Organization Active NPI Hospitalist Physician · Abingdon, VA
NPI 1104171826 · NPPES record last updated Mar 28, 2019
Key facts
- NPI
- 1104171826
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hospitalist Physician 208M00000X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Practice address
- 16000 Johnston Memorial Dr
Fourth Floor
Abingdon, VA 24211-7664 - Phone
- (276) 258-4050
- Fax
- (276) 258-4056
- NPI assigned
- Jul 18, 2012
- Organization subpart
- No
Authorized official
- Name
- Carl Steven Kilgore
- Title
- President
- Phone
- (423) 302-3051
Corporate family (same tax ID) 15
Practitioners 57
-
Amanda Hansen, F.N.P.-C
-
Trenton Keel, D.O.
-
Lena Manning, DO
-
Brian K Miller, D.O.
-
Ayan Rufat Novruzov, D.O.
-
Ryan O'Connell, D.O.
-
Heather Renee Rose, FNP-C
-
Keri Nicole Smith, FNP-C
-
Haley Cantrell Adkins, FNP-BC
-
Eric Dakota Artrip, FNP
-
Leslie Bodo, FNP-BC
-
Melissa Broome, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040715001336 | VA | Part B Supplier - Clinic/Group Practice | 9739099441 |
Receives reassigned benefits from 340 practitioners This NPI is an additional NPI on the enrollment Practice locations: Lebanon, VA; Marion, VA; Meadowview, VA; Norton, VA; Abingdon, VA; Rural Retreat, VA; Big Stone Gap, VA; Abington, VA |
National Provider Directory
- Tax ID family
- Kingsport Internal Medi
Locations
16000 Johnston Memorial Dr
Fl Fourth
Abingdon, VA 24211
Phone (276) 258-4050
16000 Johnston Memorial Dr
Ste A
Abingdon, VA 24211
Phone (276) 258-1880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 0101246669 | VA | |
| Hospitalist Physician |
208M00000X | Yes | ||
| Physician Assistant |
363A00000X | VA | ||
| Nurse Practitioner |
363L00000X | VA |
Addresses
Primary practice location
16000 Johnston Memorial Dr
Fourth Floor
Abingdon, VA 24211-7664
Mailing address
16000 Johnston Memorial Dr
Fourth Floor
Abingdon, VA 24211-7664
Phone (276) 258-4050
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4348719 | Other | TN | BLUECARE |
| 1530896 | Medicaid | TN | |
| 1104171826 | Medicaid | VA | |
| 1104171826 | Medicaid | NC | |
| 614862402 | Other | VA | DEPARTMENT OF LABOR |
| DF9105 | Other | VA | RR MEDICARE |
| DF7910 | Other | VA | RR MEDICARE |
Other names
- Ballad Health Medical Associates
- MSMG HIMA JMH
- BHMA Hospitalists JMH
Other providers in Abingdon, VA
- Blue Ridge Medical Management Corp
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
All providers in Abingdon, VA · Hospitalist Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.