BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1093016024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093016024 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | BALLAD HEALTH MEDICAL ASSOCIATES |
| Practice Address |
410 N State of Franklin Rd Suite 130 Johnson City TN 37604-6971 |
| Practice Telephone | 4234312477 |
| Practice Fax Number | 4234312478 |
| Mailing Telephone | 4234312477 |
| Mailing Fax Number | 4234312478 |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2019-03-28 |
| Authorized Official Name | CARL S KILGORE (PRESIDENT/CEO) |
| Authorized Official Telephone | 4233023051 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XX0801X |
Orthopaedic Surgery Specialization: Orthopaedic Trauma |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2086S0127X |
Surgery Specialization: Trauma Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | DEPARTMENT OF LABOR | 020487825 | 01 |
| VA | 1093016024 | 05 | |
| NC | 5917230 | 05 | |
| TN | RAIL ROAD MEDICARE | CA5744 | 01 |
| KY | 7100203970 | 05 | |
| TN | 1522339 | 05 | |
| KY | 7100163800 | 05 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Trauma Services Johnson City | Other Name - Individual/Organization |
| MSMG Trauma JC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588128755 | Blue Ridge Medical Management Corporation | Family Medicine | 2030 Temple Hill Rd Ste B, Erwin, TN 37650-8721 | 2019-01-22 |
| 1558831115 | Blue Ridge Medical Management Corporation | Internal Medicine | 404 Bemberg Rd, Elizabethton, TN 37643 | 2018-11-27 |
| 1457821019 | Blue Ridge Medical Management Corporation | Internal Medicine | 71 S Flannagan Ave Suite 81, Lebanon, VA 24266 | 2018-11-27 |
| 1255816252 | Blue Ridge Medical Management Corporation | Clinic/Center | 1901 S Shady St Ste A, Mountain City, TN 37683-2021 | 2018-09-26 |
| 1184105272 | Blue Ridge Medical Management Corporation | Ophthalmology | 410 N State of Franklin Rd Ste 130b, Johnson City, TN 37604-6972 | 2018-08-27 |
| 1841770864 | Blue Ridge Medical Management Corporation | Pediatrics | 408 N State of Franklin Rd Ste 31g, Johnson City, TN 37604-6088 | 2018-08-20 |
| 1568958775 | Blue Ridge Medical Management Corporation | Urology | 408 N State of Franklin Rd Ste 31f, Johnson City, TN 37604-6088 | 2018-07-11 |
| 1477055317 | Blue Ridge Medical Management Corporation | Urology | 16000 Johnston Memorial Dr Ste 309, Abingdon, VA 24211-7664 | 2018-03-07 |
| 1669903803 | Blue Ridge Medical Management Corporation | Internal Medicine | 1497 W Elk Ave Ste 22b, Elizabethton, TN 37643-2896 | 2017-03-21 |
| 1245771757 | Blue Ridge Medical Management Corporation | Internal Medicine | 1410 Park Ave Nw, Norton, VA 24273 | 2017-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION | 303 Med Tech Parkway, Johnson City, Tennessee 37604 |
| North Carolina Corporations | Blue Ridge Medical Management Corporation | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Street Address |
410 N STATE OF FRANKLIN RD SUITE 130 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-6971 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346248028 | Brian Mason | Radiology | 410 N State of Franklin Rd, Suite 135b, Johnson City, TN 37604-6971 | 2005-07-07 |
| 1356880199 | Shriners Hospitals for Children | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2017-02-13 |
| 1043688385 | Blue Ridge Medical Management Corporation | Radiology | 410 N State of Franklin Rd, Suite 135b, Johnson City, TN 37604 | 2015-09-03 |
| 1659776375 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604-6971 | 2014-10-23 |
| 1003152307 | Blue Ridge Medical Management Corporation | Neurological Surgery | 410 N State of Franklin Rd, Suite 120, Johnson City, TN 37604-6971 | 2012-12-14 |
| 1134497787 | Ted Allan White | Nurse Practitioner | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2011-12-12 |
| 1518266725 | William Andrew Crabtree | Physician Assistant | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2011-03-28 |
| 1245559236 | Tanzid Shams | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604 | 2010-05-31 |
| 1275867715 | Brandon Green | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2009-10-01 |
| 1801022975 | John Benjamin Yarger | Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2009-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 2086S0127X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Trauma Surgery |
| Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. |
| Notes: Source: American Board of Surgery, 2007 [1/1/2008: definition added, source added] Additional Resources: http://www.absurgery.org/. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316380744 | Davis Pappandreou Berry | Surgery | University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37920-0000 | 2013-04-16 |
| 1285679076 | Mid-south Surgery Associates, Pllc | Surgery | 686 W Forest Ave, Jackson, TN 38301-3940 | 2006-06-17 |
| 1861055964 | Brian J Thompson | Surgery | 3601 The Vanderbilt Clinic, Nashville, TN 37232-0001 | 2019-04-15 |
| 1679912604 | Sneha G Bhat | Surgery | 1924 Alcoa Hwy # U-11, Knoxville, TN 37920 | 2013-06-24 |
| 1417393489 | Michael Scott Lallemand | Surgery | 3601 The Vanderbilt Clinic, Nashville, TN 37232-1000 | 2013-05-17 |
| 1083956486 | Keelin Flannery Roche | Surgery | 3601 The Vanderbilt Clinic, Nashville, TN 37232-2635 | 2013-03-23 |
| 1689921496 | Ronnie N. Mubang | Surgery | 3601 The Vanderbilt Clinic, Nashville, TN 37232-0001 | 2012-08-10 |
| 1376770016 | Stephen Paul Gondek | Surgery | 1211 21st Ave S, Nashville, TN 37212 | 2009-06-21 |
| 1922254622 | Christy Marie Lawson | Surgery | 1932 Alcoa Hwy, Building C Suite 270, Knoxville, TN 37920-1527 | 2008-08-13 |
| 1164626594 | Michael Joseph Krzyzaniak | Surgery | 1211 21st Ave S, 404 Medical Arts Building, Nashville, TN 37212-2717 | 2007-06-11 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.