Active NPI
Blue Ridge Cardiology and Internal Medicine PA
- Cardiovascular Disease Physician
- Elkin, NC
National Provider Identifier
1851363311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- Legal business name
- BLUE RIDGE CARDIOLOGY AND INTERNAL MEDICINE PA
- Practice address
- 640 Parkwood Medical Park
Elkin, NC 28621-2487 - Phone
- (336) 526-7997
- Fax
- (336) 526-3537
- NPI assigned
- Feb 7, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Tomas Vybiral, M.D.
- Title
- Ceo
- Phone
- (336) 526-7997
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | NC | ||
| Cardiovascular Disease Physician | 207RC0000X | NC | Primary | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | NC |
Addresses
Primary practice location
640 Parkwood Medical Park
Elkin, NC 28621-2487
Mailing address
PO Box 249
Yadkinville, NC 27055-0249
Phone (336) 679-4963
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0286K | Other | NC | BCBS OF NC GROUP NUMBER |
| 890286K | Medicaid | NC | |
| 21388 | Other | NC | MEDCOST GROUP NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040310000587 | NC | Part B Supplier - Clinic/Group Practice | 7719875707 |
Receives reassigned benefits from 7 practitioners Practice locations: Yadkinville, NC; North Wilkesboro, NC; Mt Airy, NC; Elkin, NC |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0882800 | Blue Ridge Cardiology & Internal Med | Certificate of waiver | Feb 17, 2028 |
National Provider Directory
National Provider DirectoryLocations
380 Parkwood Medical Park
Elkin, NC 28621
Phone (336) 526-7997
905 Rockford St
Mount Airy, NC 27030
Phone (336) 719-2440
665 S Main St
Ste 13
Sparta, NC 28675
Phone (336) 372-5911
108 N State St
Yadkinville, NC 27055
108 S State St
Yadkinville, NC 27055
Phone (336) 679-2733
Practitioners & affiliated clinicians
Practitioners 16
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Geriatric Medicine (Internal Medicine) Physician
- Elkin, NC
- NPI 1700858404
Internal Medicine, NC
-
- Family Nurse Practitioner
- Winston Salem, NC
- NPI 1952581464
-
- Nurse Practitioner
- Winston Salem, NC
- NPI 1750651790
-
- Nurse Practitioner
- Winston Salem, NC
- NPI 1700121738
-
- Nurse Practitioner
- Valdese, NC
- NPI 1023636933
-
- Internal Medicine Physician
- Raleigh, NC
- NPI 1952322406
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1377216000000",
"number": "1851363311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 249",
"city": "YADKINVILLE",
"state": "NC",
"postal_code": "270550249",
"telephone_number": "336-679-4963",
"fax_number": "336-679-2549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 PARKWOOD MEDICAL PARK",
"city": "ELKIN",
"state": "NC",
"postal_code": "286212487",
"telephone_number": "336-526-7997",
"fax_number": "336-526-3537"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLUE RIDGE CARDIOLOGY AND INTERNAL MEDICINE PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-07",
"last_updated": "2013-08-23",
"status": "A",
"authorized_official_last_name": "VYBIRAL",
"authorized_official_first_name": "TOMAS",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "336-526-7997",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "NC",
"license": null,
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NC",
"license": null,
"primary": true
},
{
"code": "207RG0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NC",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC GROUP NUMBER",
"identifier": "0286K",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890286K",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST GROUP NUMBER",
"identifier": "21388",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkin, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.