Blue Ridge Medical Management Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

MSMG Im Eliz

Practice address

314 Rogosin Dr
Suite B
Elizabethton, TN 37643-2904

Phone

(423) 547-2761

Fax

(423) 542-8621

NPI assigned

May 27, 2009

Last updated

Oct 29, 2010By 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 2

Other names 1

• MSMG IM ELIZ Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 4

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.

• Buddy J Clayton, MD

  • Family Medicine Physician
  • Elizabethton, TN
  • NPI 1477525699
  NPD (past)
• Heather L Coburn, PA-C

  • Medical Physician Assistant
  • Johnson City, TN
  • NPI 1932165545
  NPD (past)
• Faith Tolan, PA

  • Physician Assistant
  • Johnson City, TN
  • NPI 1699723866
  NPD (past)
• Steven Brian Clayton, MD

  • Gastroenterology Physician
  • Winston Salem, NC
  • NPI 1144292459
  NPD (past)

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

{
    "created_epoch": "1243382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1619102167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3700",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376023700",
            "telephone_number": "866-397-1439",
            "fax_number": "423-262-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 ROGOSIN DR",
            "address_2": "SUITE B",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432904",
            "telephone_number": "423-547-2761",
            "fax_number": "423-542-8621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-27",
        "last_updated": "2010-10-29",
        "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": "1513567",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619102167",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG IM ELIZ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (Dba MSMG FP Eliz)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (MSMG FM Elizabethton B)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (MSMG Ortho Eliz)
• Blue Ridge Medical Management Corporation (DBA Mountain Empire Medical & Surgical Associates)
• Grace Reddick Gerlock Boerma, APN

• Internal Medicine Physician in Elizabethton, TN
• Providers in Elizabethton, 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 Oct 29, 2010; 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.