NPIMap

Organization Active NPI

Blue Ridge Healthcare Medical Group, Inc.

Doing business as Alan F. Jacks, MD, PA

  • Surgery Physician
  • Connelly Springs, NC
National Provider Identifier
1740558949
Registry record updated Feb 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
969601640 Issued in NC
Legal business name
BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Doing business as
Alan F. Jacks, MD, PA
Practice address
845 Malcolm Boulevard
Connelly Springs, NC 28612-8615
Phone
(828) 580-3555
Fax
(828) 874-2111
NPI assigned
Dec 2, 2011
Last updated
Feb 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 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
Surgery Physician 208600000X 969601640 NC Primary

Addresses

Primary practice location

845 Malcolm Boulevard
Connelly Springs, NC 28612-8615

Mailing address

845 Malcolm Boulevard
Connelly Springs, NC 28612-8615
Phone (828) 580-3555

Other identifiers 1

IdentifierTypeStateIssuer
2327875OtherNCMEDICARE PTAN

Other names 1

  • Alan F. Jacks, MD, PA 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 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1740558949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 MALCOLM BOULEVARD",
            "city": "CONNELLY SPRINGS",
            "state": "NC",
            "postal_code": "286128615",
            "telephone_number": "828-580-3555",
            "fax_number": "828-874-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 MALCOLM BOULEVARD",
            "city": "CONNELLY SPRINGS",
            "state": "NC",
            "postal_code": "286128615",
            "telephone_number": "828-580-3555",
            "fax_number": "828-874-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-02",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "969601640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "2327875",
            "state": "NC"
        }
    ],
    "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": "Alan F. Jacks, MD, PA",
            "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 Feb 6, 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.