Blue Ridge Medical Management Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

MSMG Hima Ucmh

Practice address

100 Greenway Cir
Erwin, TN 37650-2177

Phone

(423) 431-1810

Fax

(423) 431-1811

NPI assigned

May 15, 2014

Last updated

Dec 3, 2014By 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 Steven Kilgore

Title

President

Phone

(423) 915-5100

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• MSMG HIMA UCMH Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1912318635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GREENWAY CIR",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502177",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GREENWAY CIR",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502177",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-915-5100"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912318635",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q006137",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG HIMA UCMH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• James Alexander Bowden, MD
• Bradshaw Family Medical, LLC
• Brighter Day Home Care LLC (Brighter Days Home Care East)

• Internal Medicine Physician in Erwin, TN
• Providers in Erwin, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.