Blue Ridge Medical Management Corporation

Key facts

NPI: 1497057491
Entity type: Organization (NPI type 2)
Primary specialty: Neurological Surgery Physician 207T00000X
Legal business name: BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Practice address: 16000 Johnston Memorial Dr
Suite 312a
Abingdon, VA 24211-7659
Phone: (423) 431-2350
Fax: (423) 431-2372
NPI assigned: Nov 23, 2010
Organization subpart: No

Authorized official

Name: Carl Steven Kilgore
Title: President/Ceo
Phone: (423) 302-3051

Practitioners 2

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

Cynthia A Logan, MD Family Medicine Physician · Mills River, NC · NPI 1306817259

NPD
Brian D Russell, FNP-BC Family Nurse Practitioner · Norwell, MA · NPI 1992021315

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 312A
Abingdon, VA 24211
Phone (423) 431-2350

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Neurological Surgery Physician Group: 193400000X SINGLE SPECIALTY GROUP	207T00000X			Yes

Addresses

Primary practice location

16000 Johnston Memorial Dr
Suite 312a
Abingdon, VA 24211-7659

Mailing address

16000 Johnston Memorial Dr
Suite 312a
Abingdon, VA 24211-7659
Phone (423) 431-2350

Other identifiers

Identifier	Type	State	Issuer
1497057491	Medicaid	VA

Other names

Ballad Health Medical Associates Doing business as
MSMG NEUROSURG ABG Doing business as
BHMA Neurosurgery and Spine Abingdon Other name

Other providers in Abingdon, VA

All providers in Abingdon, VA · Neurological Surgery Physician in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2019. 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.