Blue Ridge Urology PA

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

BLUE RIDGE UROLOGY PA

Practice address

402 Memorial Drive Extension
Greer, SC 29651

Phone

(864) 877-0779

Fax

(864) 877-7801

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John E Walton, MDNPI 1376632703

Title

Owner

Phone

(864) 877-0779

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• John Edmond Walton, MD

  • Urology Physician
  • Greer, SC
  • NPI 1376632703

  SC

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1487751699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 MEMORIAL DRIVE EXTENSION",
            "city": "GREER",
            "state": "SC",
            "postal_code": "29651",
            "telephone_number": "864-877-0779",
            "fax_number": "864-877-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 MEMORIAL DRIVE EXTENSION",
            "city": "GREER",
            "state": "SC",
            "postal_code": "29651",
            "telephone_number": "864-877-0779",
            "fax_number": "864-877-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE UROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-877-0779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3677",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "89014MU",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Cline Blanton
• Margaret Funderburk Blauert, PHARMD
• Blossom Obstetrics, Gynecology & Infertility, P.a.
• Blue Ridge Connections ABA LLC
• Blue Ridge Laser Eye Associates, P.a.
• Blue Ridge Vision Associates. PA
• Anna Blue
• Camryn Blume, RBT
• Monica Aileen Boada-Cordova, RN
• Body Works Physical Therapy, LLC

• All providers in Greer, SC
• Urology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.