NPIMap

Organization Active NPI

Blue Ridge Cardiology and Internal Medicine PA

  • Cardiovascular Disease Physician
  • Elkin, NC
National Provider Identifier
1851363311
Registry record updated Aug 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
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
Last updated
Aug 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2013

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

Authorized official

Name
Dr. Tomas Vybiral, M.D.NPI 1740285824
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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X NC
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X NC Primary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0882800Blue Ridge Cardiology & Internal Med640 Parkwood Medical Park, Elkin, NC 28621Certificate of waiverFeb 17, 2028

National Provider Directory

National Provider Directory

Locations

640 Parkwood Medical Park
Elkin, NC 28621
Phone (336) 526-7997

665 S Main St
Ste 13
Sparta, NC 28675
Phone (336) 372-5911

108 N State St
Yadkinville, NC 27055

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": "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": [],
    "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.

Verify at the official NPI Registry.