NPIMap

Organization Active NPI

Blue Ridge Integrative Wellness LLC

  • General Practice Physician
  • Dryden, VA
National Provider Identifier
1164394177
Registry record updated Sep 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
BLUE RIDGE INTEGRATIVE WELLNESS LLC
Practice address
512 Dryden Loop
Dryden, VA 24243
Phone
(941) 391-7261
NPI assigned
Sep 19, 2025
Last updated
Sep 18, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2026

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

Authorized official

Name
Tracy Rogers, OWNERNPI 1730005083
Title
Owner
Phone
(941) 391-7261

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU
Infusion Therapy Clinic/Center 261QI0500X NU
Physical Therapy Clinic/Center 261QP2000X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Occupational Medicine Clinic/Center 261QX0100X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

512 Dryden Loop
Dryden, VA 24243

Mailing address

512 Dryden Loop
Dryden, VA 24243-8366
Phone (252) 452-6075

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260220000067 VA Part B Supplier - Clinic/Group Practice 3971084724 Receives reassigned benefits from 1 practitioner
Practice locations: Dryden, VA

National Provider Directory

National Provider Directory
Tax ID family
Blue Ridge Integrative Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1758240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789689600000",
    "number": "1164394177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 DRYDEN LOOP",
            "city": "DRYDEN",
            "state": "VA",
            "postal_code": "242438366",
            "telephone_number": "252-452-6075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 DRYDEN LOOP",
            "city": "DRYDEN",
            "state": "VA",
            "postal_code": "24243",
            "telephone_number": "941-391-7261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE INTEGRATIVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-19",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-18",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-391-7261",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dryden, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; 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.