NPIMap

Organization Active NPI

Blue Ridge Ear, Nose and Throat, Inc.

  • Otolaryngology Physician
  • Boone, NC
National Provider Identifier
1285846493
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
009400056 Issued in NC
Legal business name
BLUE RIDGE EAR, NOSE AND THROAT, INC.
Practice address
870 State Farm Rd
Suite 101
Boone, NC 28607-4861
Phone
(828) 264-4545
Fax
(828) 264-3279
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Dr. Charles W Ford Jr., M.D.NPI 1164481727
Title
President
Phone
(828) 264-4545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 009400056 NC Primary

Addresses

Primary practice location

870 State Farm Rd
Suite 101
Boone, NC 28607-4861

Mailing address

870 State Farm Rd
Suite 101
Boone, NC 28607-4861
Phone (828) 264-4545

Other identifiers 1

IdentifierTypeStateIssuer
8932979MedicaidNC

Other names 1

  • Charles W. Ford, M.D., P.A. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000730 NC Part B Supplier - Clinic/Group Practice 6901719434 Receives reassigned benefits from 14 practitioners
Practice locations: Boone, NC; North Wilkesboro, NC

National Provider Directory

National Provider Directory

Locations

400 Shadowline Dr
Ste 201
Boone, NC 28607
Phone (828) 264-4545

200 Hospital Ave
#3
Jefferson, NC 28640
Phone (336) 846-7433

436 Hospital Dr
Ste 240
Newland, NC 28657

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1285846493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 STATE FARM RD",
            "address_2": "SUITE 101",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286074861",
            "telephone_number": "828-264-4545",
            "fax_number": "828-264-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 STATE FARM RD",
            "address_2": "SUITE 101",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286074861",
            "telephone_number": "828-264-4545",
            "fax_number": "828-264-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE EAR, NOSE AND THROAT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-264-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "009400056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8932979",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles W. Ford, M.D., P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Charles W. Ford, M.D., P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boone, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.