NPIMap

Organization Active NPI

Blue Ridge Medical Management Corporation

Doing business as Ballad Health Medical Associates

  • Pediatrics Physician
  • Kingsport, TN
National Provider Identifier
1992105431
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Doing business as
Ballad Health Medical Associates
MSMG Peds KPT
Practice address
2002 Brookside Dr
Suite 200
Kingsport, TN 37660-4634
Phone
(423) 224-3933
Fax
(423) 224-3934
NPI assigned
Sep 3, 2014
Last updated
May 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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) 302-3051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2002 Brookside Dr
Suite 200
Kingsport, TN 37660-4634

Mailing address

2002 Brookside Dr
Suite 200
Kingsport, TN 37660-4634
Phone (423) 224-3933

Other identifiers 2

IdentifierTypeStateIssuer
Q008812MedicaidTN
1992105431MedicaidVA

Other names 3

  • Ballad Health Medical Associates Doing business as
  • MSMG PEDS KPT Doing business as
  • BHMA Pediatrics Kingsport Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031204000996 TN Part B Supplier - Clinic/Group Practice 9739099441 Receives reassigned benefits from 562 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Johnson City, TN; Kingsport, TN; Mountain City, TN; Elizabethton, TN; Erwin, TN; Greeneville, TN

National Provider Directory

National Provider Directory

Locations

2002 Brookside Dr
Ste 200
Kingsport, TN 37660
Phone (423) 224-3933

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746144000000",
    "number": "1992105431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DR",
            "address_2": "SUITE 200",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-224-3933",
            "fax_number": "423-224-3934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DR",
            "address_2": "SUITE 200",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-224-3933",
            "fax_number": "423-224-3934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-03",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "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": "423-302-3051"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008812",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992105431",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballad Health Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MSMG PEDS KPT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BHMA Pediatrics Kingsport",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2025; 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.