NPIMap

Organization Active NPI

Blue Ridge Pulmonary Medicine, PC

  • Pulmonary Disease Physician
  • Cleveland, TN
National Provider Identifier
1487601019
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
BLUE RIDGE PULMONARY MEDICINE, PC
Practice address
110 Dunhill PL NW
Cleveland, TN 37311-3883
Phone
(423) 476-2212
Fax
(423) 476-7022
NPI assigned
May 28, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
John S. Jaggers IIINPI 1568403178
Title
President
Phone
(423) 476-2212

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

Practitioners 13

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

View all 13

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060804000044 TN Part B Supplier - Clinic/Group Practice 3678586963 Receives reassigned benefits from 6 practitioners
Practice locations: Dayton, TN; Cleveland, TN

National Provider Directory

National Provider Directory

Locations

301 White Oak Rd
Ste 101
Dayton, TN 37321

7794 Rhea County Hwy
Ste 103
Dayton, TN 37321
Phone (423) 332-7373

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

NPPES NPI Registry

Primary practice location

110 Dunhill PL NW
Cleveland, TN 37311-3883

Mailing address

110 Dunhill PL NW
Cleveland, TN 37311-3883
Phone (423) 476-2212

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
3702756MedicaidTN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 1, 2009.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243814400000",
    "number": "1487601019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 DUNHILL PL NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113883",
            "telephone_number": "423-476-2212",
            "fax_number": "423-476-7022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 DUNHILL PL NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113883",
            "telephone_number": "423-476-2212",
            "fax_number": "423-476-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE PULMONARY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2009-06-01",
        "status": "A",
        "authorized_official_last_name": "JAGGERS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-476-2212",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3702756",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; 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.