NPIMap

Organization Active NPI

Blue Ridge Pediatrics LLC

  • Pediatric Adolescent Medicine Physician
  • Seneca, SC
National Provider Identifier
1457324907
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
246601 Issued in SC
Legal business name
BLUE RIDGE PEDIATRICS LLC
Practice address
457-B Highway 123 Bypass
Seneca, SC 29678
Phone
(864) 888-4464
Fax
(864) 888-4462
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Authorized official

Name
Dr. Carey Molin Gully, M.D.NPI 1326066564
Title
Owner/Physician
Phone
(864) 888-4464

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X 246601 SC Primary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X 101794 SC

Addresses

Primary practice location

457-B Highway 123 Bypass
Seneca, SC 29678

Mailing address

457B Highway 123
Seneca, SC 29678-0842
Phone (864) 888-4464

Other identifiers 2

IdentifierTypeStateIssuer
RHC195MedicaidSC
GP1060MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Blue Ridge Pediatrics LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

457B By Pass 123
Seneca, SC 29678

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1457324907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457B HIGHWAY 123",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296780842",
            "telephone_number": "864-888-4464",
            "fax_number": "864-888-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457-B HIGHWAY 123 BYPASS",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "29678",
            "telephone_number": "864-888-4464",
            "fax_number": "864-888-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "GULLY",
        "authorized_official_first_name": "CAREY",
        "authorized_official_middle_name": "MOLIN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "864-888-4464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "SC",
            "license": "246601",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "SC",
            "license": "101794",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC195",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1060",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seneca, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.