Blue Ridge Healthcare Medical Group, Inc.
Organization Active NPI Gastroenterology Physician · Marion, NC
NPI 1396017752 · NPPES record last updated Feb 13, 2025
Key facts
- NPI
- 1396017752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 2012-00598 (ND)
- Legal business name
- BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
- Practice address
- 2293 Sugar Hill Rd
Suite B
Marion, NC 28752-7787 - Phone
- (828) 559-2016
- NPI assigned
- Feb 1, 2012
- Organization subpart
- No
Authorized official
- Name
- Patricia Moll
- Title
- SVP-Cfo
- Phone
- (828) 580-5003
Corporate family (same tax ID) 35
Practitioners 11
-
Mark Richard Brady, M.D.
-
Rebekah Clark Elliott, PA-C
-
Elie Fares, MD
-
Laura Hill Holloway, MSPT
-
David B Mann, M.D.
-
Rhett Churchill Mays, M.D.
-
Silpa Rao, M.D.
-
Raven S Young, FNP-C
-
Christopher Shank, M.D.
-
Amy Smith Ende, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070110000601 | NC | Part B Supplier - Clinic/Group Practice | 9436159712 |
Receives reassigned benefits from 346 practitioners This NPI is an additional NPI on the enrollment Practice locations: Morganton, NC; Marion, NC; Morgantown, NC; Nebo, NC; Valdese, NC; Winterville, NC; Connelly Springs, NC; Granite Falls, NC… |
National Provider Directory
- Tax ID family
- Blue Ridge Hlthcare Med GRP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician |
207RC0200X | 2004-01186 | NC | |
| Gastroenterology Physician |
207RG0100X | 2012-00598 | ND | Yes |
| Pulmonary Disease Physician |
207RP1001X | 2004-01186 | NC |
Addresses
Primary practice location
2293 Sugar Hill Rd
Suite B
Marion, NC 28752-7787
Mailing address
2293 Sugar Hill Rd
Suite B
Marion, NC 28752-7787
Phone (828) 559-2016
Other names
- Blue Ridge Multi Specialty Clinic - Marion
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Marion, NC
- Brady Blanton
- Blue Ridge Chiropractic Clinic PA
- Blue Ridge Healthcare Medical Group, Inc
- Blue Ridge Healthcare Medical Group, Inc
- Blue Ridge Healthcare Medical Group, Inc.
- Blue Ridge Healthcare Medical Group, Inc.
- Blue Ridge Healthcare Medical Group, Inc.
- Blue Ridge Healthcare Medical Group, Inc.
- Blue Ridge Healthcare Medical Group, Inc.
- Blue Ridge Home Care
All providers in Marion, NC · Gastroenterology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2025. 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.