Blue Ridge Medical Management

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT

Doing business as

MSMG Gen Surg Erwin

Practice address

630 Oneega LN
Suite D
Erwin, TN 37650-2197

Phone

(423) 542-7440

Fax

(423) 542-7445

NPI assigned

Mar 5, 2015

Last updated

Feb 14, 2017By 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 Stephen Kilgore

Title

President

Phone

(423) 915-5116

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MSMG GEN SURG ERWIN Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 2

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.

• Elizabeth Anne Defluiter, MD

  • Surgery Physician
  • Elizabethton, TN
  • NPI 1255363347
  NPD
• Timothy Michael Fullagar, M.D.

  • Neurological Surgery Physician
  • Johnson City, TN
  • NPI 1629088364
  NPD

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

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1811380520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ONEEGA LN",
            "address_2": "SUITE D",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502197",
            "telephone_number": "423-542-7440",
            "fax_number": "423-542-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ONEEGA LN",
            "address_2": "SUITE D",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502197",
            "telephone_number": "423-542-7440",
            "fax_number": "423-542-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-05",
        "last_updated": "2017-02-14",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-915-5116"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q012234",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG GEN SURG ERWIN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thom Edd Barry, LCSW
• Barbe Anne Bartlett, BS
• Ashley Bennett, NP
• Laura Kay Berry, APRN, FNP
• Joseph Edward Bieberly, M.D.
• Blue Ridge Medical Management C Orporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation (Ballad Health)

• Surgery Physician in Erwin, TN
• Providers in Erwin, TN by specialty
• Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.