NPIMap

Organization Active NPI

Blue Ridge Medical Management Corporation

Doing business as MSMG OB GYN Mar a

  • Obstetrics & Gynecology Physician
  • Marion, VA
National Provider Identifier
1114219805
Registry record updated Jan 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Doing business as
MSMG OB GYN Mar a
Practice address
1205 Snider St
Marion, VA 24354-4221
Phone
(276) 783-2354
Fax
(276) 783-2754
NPI assigned
May 12, 2011
Last updated
Jan 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2016

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

Authorized official

Name
Mr. Carl Steven Kilgore
Title
President
Phone
(423) 915-5116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1205 Snider St
Marion, VA 24354-4221

Mailing address

1205 Snider St
Marion, VA 24354-4221
Phone (276) 783-2354

Other identifiers 2

IdentifierTypeStateIssuer
DT9105OtherVARR MEDICARE
1114219805MedicaidVA

Other names 1

  • MSMG OB GYN MAR A Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453075200000",
    "number": "1114219805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 SNIDER ST",
            "city": "MARION",
            "state": "VA",
            "postal_code": "243544221",
            "telephone_number": "276-783-2354",
            "fax_number": "276-783-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 SNIDER ST",
            "city": "MARION",
            "state": "VA",
            "postal_code": "243544221",
            "telephone_number": "276-783-2354",
            "fax_number": "276-783-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2016-01-18",
        "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": "423-915-5116",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DT9105",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114219805",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG OB GYN MAR A",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; 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.