Blue Ridge Medical Management Corporation

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Practice address

2205 Pavilion Dr
Suite 102
Kingsport, TN 37660-4641

Phone

(423) 929-7393

Fax

(423) 929-1427

NPI assigned

Jun 25, 2009

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) 915-5100

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• MSMG CVT KPT Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremy Nathan Elliott, DO

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1124043120
  NPD
• Erin Andrea Koscinski, D.O

  • Family Medicine Physician
  • Abingdon, VA
  • NPI 1184936742
  NPD

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1144458332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 PAVILION DR",
            "address_2": "SUITE 102",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604641",
            "telephone_number": "423-929-7393",
            "fax_number": "423-929-1427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 PAVILION DR",
            "address_2": "SUITE 102",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604641",
            "telephone_number": "423-929-7393",
            "fax_number": "423-929-1427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-25",
        "last_updated": "2010-10-27",
        "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": "423-915-5100"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1515098",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG CVT KPT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bloomingdale Drug of Kingsport, LLC
• Blue Ridge Medical Management
• Blue Ridge Medical Management Corp
• 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

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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.