Blue Ridge Medical Management Corporation

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Practice address

311 Princeton Rd
Suite 7
Johnson City, TN 37601-2026

Phone

(423) 282-3236

Fax

(423) 283-4746

NPI assigned

Jul 7, 2006

Organization subpart

No

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

Authorized official

Name

Carl S Kilgore

Title

President

Phone

(423) 915-5100

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Cardiology Consultants of Johnson City Doing business as

Medicare fee-for-service enrollment

Enrolled in TN, VA2 enrollments

Enrollment records 2

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robin Malinda Butler, FNP

  • Family Nurse Practitioner
  • Bristol, TN
  • NPI 1861832081
  NPD
• Steven Croghan, NP

  • Family Nurse Practitioner
  • Kingsport, TN
  • NPI 1932646163
  NPD
• Jonathan Trego Swank, MD

  • Internal Medicine Physician
  • Abingdon, VA
  • NPI 1750459228
  NPD
• Harold Wayne Alison, MD

  • Interventional Cardiology Physician
  • Johnson City, TN
  • NPI 1710096938

  Cardiovascular Disease

  NPD (past)
• Albert Robert Blacky, M.D.

  • Interventional Cardiology Physician
  • Knoxville, TN
  • NPI 1699762252

  Cardiovascular Disease

  NPD (past)
• Vipulkumar R Brahmbhatt, MD

  • Clinical Cardiac Electrophysiology Physician
  • Johnson City, TN
  • NPI 1679559165

  Cardiovascular Disease

  NPD (past)
• Mark Wan Soo Chang, MD

  • Interventional Cardiology Physician
  • Johnson City, TN
  • NPI 1174632475

  Cardiovascular Disease

  NPD (past)
• Israel D. Garcia, MD

  • Cardiovascular Disease Physician
  • Kingsport, TN
  • NPI 1598750481
  NPD (past)
• Fawwaz I. Hamati, MD

  • Interventional Cardiology Physician
  • Johnson City, TN
  • NPI 1225023104

  Cardiovascular Disease

  NPD (past)
• Shobha R. Hiremagalur, MD

  • Interventional Cardiology Physician
  • Johnson City, TN
  • NPI 1407841398

  Cardiovascular Disease

  NPD (past)
• Ahmed A. Khan, MD

  • Interventional Cardiology Physician
  • Johnson City, TN
  • NPI 1639165277

  Cardiovascular Disease

  NPD (past)
• Christopher W. Sholes, MD

  • Cardiovascular Disease Physician
  • Johnson City, TN
  • NPI 1316932205
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1962434068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD",
            "address_2": "SUITE 7",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012026",
            "telephone_number": "423-282-3236",
            "fax_number": "423-283-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD",
            "address_2": "SUITE 7",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012026",
            "telephone_number": "423-282-3236",
            "fax_number": "423-283-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-915-5100"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890117J",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3702646",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CD7031",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF NC",
            "identifier": "02571",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiology Consultants of Johnson City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Management Corporation
• Blue Ridge Medical Mangement Corporation
• Blue Ridge Physical Therapy, Inc.
• Patrick Holloway Blythe

• Cardiovascular Disease Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Cardiovascular Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; 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.