Blue Ridge Medical Management Corporation

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

MSMG Ortho Eliz

Practice address

1503 W Elk Ave
Suite 3
Elizabethton, TN 37643-2876

Phone

(423) 542-3806

Fax

(423) 542-3814

NPI assigned

Aug 9, 2006

Last updated

Oct 26, 2010By 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

C Steven Kilgore

Title

Senior Vice President

Phone

(423) 915-5100

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• MSMG ORTHO ELIZ Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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.

• Hadi E El Bazouni, MD

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1477632750
  NPD
• Constance Alexis Hardy, M.D.

  • Hospitalist Physician
  • Joplin, MO
  • NPI 1568409829
  NPD

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1831100767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 W ELK AVE",
            "address_2": "SUITE 3",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432876",
            "telephone_number": "423-542-3806",
            "fax_number": "423-542-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 W ELK AVE",
            "address_2": "SUITE 3",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432876",
            "telephone_number": "423-542-3806",
            "fax_number": "423-542-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "423-915-5100"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3377133",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG ORTHO ELIZ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blue Ridge Medical Management Corporation (Dba MSMG FP Eliz)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (MSMG Im Eliz)
• Blue Ridge Medical Management Corporation (MSMG FM Elizabethton B)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
• Blue Ridge Medical Management Corporation (DBA Mountain Empire Medical & Surgical Associates)
• Grace Reddick Gerlock Boerma, APN
• Heather Nicole Bolton
• Ashley Danielle Bowman, PMHNP
• Kathryn Sue Bowman, RN

• Orthopaedic Surgery Physician in Elizabethton, TN
• Providers in Elizabethton, TN by specialty
• Orthopaedic Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; 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.