Blue Ridge Medical Management Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

MSMG FP Im KPT

Practice address

2202 N John B Dennis Hwy
Suite 204
Kingsport, TN 37660-5904

Phone

(423) 229-7777

Fax

(423) 229-7776

NPI assigned

Apr 9, 2007

Last updated

Mar 31, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carl Steven Kilgore

Title

President

Phone

(423) 915-5185

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MSMG FP IM KPT Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 1

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.

• Jill Hughes

  • Family Nurse Practitioner
  • Johnson City, TN
  • NPI 1013364785
  NPD

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301529600000",
    "number": "1467575001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 N JOHN B DENNIS PKWY",
            "address_2": "SUITE 204",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605887",
            "telephone_number": "423-229-7777",
            "fax_number": "423-229-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 N JOHN B DENNIS HWY",
            "address_2": "SUITE 204",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605904",
            "telephone_number": "423-229-7777",
            "fax_number": "423-229-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2011-03-31",
        "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": "423-915-5185"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3716296",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG FP IM KPT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Blue Ridge Medical Management Corporation (MSMG Neuro KPT)

• Internal Medicine Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; 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.