Blue Ridge Medical Management Corporation

Key facts

NPI: 1457795585
Entity type: Organization (NPI type 2)
Primary specialty: Specialist 174400000X
Legal business name: BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Practice address: 16000 Johnston Memorial Dr
Suite 213a
Abingdon, VA 24211-7659
Phone: (276) 258-1985
Fax: (276) 258-1989
NPI assigned: Apr 19, 2013
Organization subpart: No

Authorized official

Name: Carl Steven Kilgore
Title: President
Phone: (423) 915-5116

Practitioners 3

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

Shannon Fullen-Roberts Family Nurse Practitioner · Abingdon, VA · NPI 1245645118

NPD
Jennifer Quesinberry Jennings, MD Family Medicine Physician · Marion, VA · NPI 1205890050

NPD
Heather Brown Family Nurse Practitioner · Johnson City, TN · NPI 1174029524

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in VA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040715001336	VA	Part B Supplier - Clinic/Group Practice	9739099441	Receives reassigned benefits from 340 practitioners This NPI is an additional NPI on the enrollment Practice locations: Lebanon, VA; Marion, VA; Meadowview, VA; Norton, VA; Abingdon, VA; Rural Retreat, VA; Big Stone Gap, VA; Abington, VA

National Provider Directory

Locations

16000 Johnston Memorial Dr
Ste 213A
Abingdon, VA 24211
Phone (276) 258-1985

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Specialist Group: 193400000X SINGLE SPECIALTY GROUP	174400000X			Yes

Addresses

Primary practice location

16000 Johnston Memorial Dr
Suite 213a
Abingdon, VA 24211-7659

Mailing address

16000 Johnston Memorial Dr
Suite 213a
Abingdon, VA 24211-7659
Phone (276) 258-1985

Other names

MSMG NEPH ABG Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 19, 2013.

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366329600000",
    "number": "1457795585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "address_2": "SUITE 213A",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-1985",
            "fax_number": "276-258-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "address_2": "SUITE 213A",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-1985",
            "fax_number": "276-258-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2013-04-19",
        "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": "423-915-5116"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG NEPH ABG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Abingdon, VA

All providers in Abingdon, VA · Specialist in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2013. 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.

Verify at the official NPI Registry.