NPIMap

Organization Active NPI

Blue Ridge Healthcare Medical Group, Inc

Doing business as The Cancer Center at Blue Ridge Valdese

  • Hematology (Internal Medicine) Physician
  • Connelly Springs, NC
National Provider Identifier
1699197012
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology (Internal Medicine) PhysicianTaxonomy code 207RH0000X
License
2009-00695 Issued in NC
Legal business name
BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC
Doing business as
The Cancer Center at Blue Ridge Valdese
Practice address
720 Malcolm Blvd
Suite 200
Connelly Springs, NC 28612-7920
Phone
(828) 580-7536
Fax
(828) 580-7537
NPI assigned
Jan 21, 2014
Last updated
Mar 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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

Authorized official

Name
Patricia Moll
Title
SVP-Cfo
Phone
(828) 580-5003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0000X 2009-00695 NC Primary

Addresses

Primary practice location

720 Malcolm Blvd
Suite 200
Connelly Springs, NC 28612-7920

Mailing address

720 Malcolm Blvd
Suite 200
Connelly Springs, NC 28612-7920
Phone (828) 580-7536

Other names 1

  • The Cancer Center at Blue Ridge Valdese Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070110000601 NC Part B Supplier - Clinic/Group Practice 9436159712 Receives reassigned benefits from 346 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Morganton, NC; Marion, NC; Morgantown, NC; Nebo, NC; Valdese, NC; Winterville, NC; Connelly Springs, NC; Granite Falls, NC…

National Provider Directory

National Provider Directory
Tax ID family
Blue Ridge Healthcare Medic36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1390262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741910400000",
    "number": "1699197012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 MALCOLM BLVD",
            "address_2": "SUITE 200",
            "city": "CONNELLY SPRINGS",
            "state": "NC",
            "postal_code": "286127920",
            "telephone_number": "828-580-7536",
            "fax_number": "828-580-7537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 MALCOLM BLVD",
            "address_2": "SUITE 200",
            "city": "CONNELLY SPRINGS",
            "state": "NC",
            "postal_code": "286127920",
            "telephone_number": "828-580-7536",
            "fax_number": "828-580-7537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-21",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A",
        "authorized_official_last_name": "MOLL",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "SVP-CFO",
        "authorized_official_telephone_number": "828-580-5003"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology",
            "state": "NC",
            "license": "2009-00695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Cancer Center at Blue Ridge Valdese",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Connelly Springs, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.