Blue Ridge Medical Management Corporation

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

Ballad Health Medical Associates
MSMG Neuro ABG

Practice address

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

Phone

(276) 258-3733

Fax

(276) 258-3734

NPI assigned

Jun 16, 2010

Last updated

Mar 29, 2019By 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 S Kilgore

Title

President

Phone

(423) 302-3051

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 3

• Ballad Health Medical Associates Doing business as
• MSMG Neuro ABG Doing business as
• BHMA Neurology Abingdon Other name

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

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.

• Melanie Ann Leight, MD

  • Obstetrics & Gynecology Physician
  • Abingdon, VA
  • NPI 1053307546
  NPD
• Rachel Anne Anderson, FNP

  • Family Nurse Practitioner
  • Johnson City, TN
  • NPI 1306208798
  NPD
• Thelma Ayensu, MD

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1881883882
  NPD
• Samuel J Potolicchio Jr., MD

  • Neurological Surgery Physician
  • Bethesda, MD
  • NPI 1114993367

  Neurology

  NPD

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553817600000",
    "number": "1669793493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "address_2": "SUITE 312",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-3733",
            "fax_number": "276-258-3734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "address_2": "SUITE 312",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-3733",
            "fax_number": "276-258-3734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2019-03-29",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-302-3051"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100161550",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR/BLACK LUNG",
            "identifier": "020487832",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR/ENERGY & FECA",
            "identifier": "020487844",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669793493",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF7910",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballad Health Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MSMG Neuro ABG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BHMA Neurology Abingdon",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (MSMG Uro Abg a)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (MSMG Uro Abg)
• Blue Ridge Medical Management Corporation (MSMG Ortho Marion)
• 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 (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (First Assist Urgent Care)

• Neurology Physician in Abingdon, VA
• Providers in Abingdon, VA by specialty
• Neurology Physician in Virginia

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