NPIMap

Organization Active NPI

Blue Ridge Medical Management Corporation

Doing business as MSMG Uro Abg

  • Urology Physician
  • Abingdon, VA
National Provider Identifier
1629362033
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Doing business as
MSMG Uro Abg
Practice address
16000 Johnston Memorial Drive
Suite 112a
Abingdon, VA 24211
Phone
(276) 258-1740
Fax
(276) 258-1745
NPI assigned
Jun 2, 2011
Last updated
Jul 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

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) 915-5116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

16000 Johnston Memorial Drive
Suite 112a
Abingdon, VA 24211

Mailing address

16000 Johnston Memorial Drive
Suite 112a
Abingdon, VA 24211
Phone (423) 952-2122

Other identifiers 1

IdentifierTypeStateIssuer
1629362033MedicaidVA

Other names 1

  • MSMG URO ABG Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

16000 Johnston Memorial Dr
Ste 112A
Abingdon, VA 24211
Phone (276) 258-1740

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436400000000",
    "number": "1629362033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DRIVE",
            "address_2": "SUITE 112A",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "24211",
            "telephone_number": "423-952-2122",
            "fax_number": "276-258-1745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DRIVE",
            "address_2": "SUITE 112A",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "24211",
            "telephone_number": "276-258-1740",
            "fax_number": "276-258-1745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2015-07-09",
        "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": "423-915-5116"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629362033",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG URO ABG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Abingdon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; 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.