BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1255341509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255341509 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | BALLAD HEALTH MEDICAL ASSOCIATES |
| Practice Address |
1021 W Oakland Ave Suite 301 Johnson City TN 37604-2191 |
| Practice Telephone | 4239528000 |
| Practice Fax Number | 4239528001 |
| Mailing Telephone | 4239528000 |
| Mailing Fax Number | 4239528001 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-03-29 |
| Authorized Official Name | CARL STEVEN KILGORE (PRESIDENT) |
| Authorized Official Telephone | 4233023051 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | Nursing & Custodial Care Facilities | ||
| N | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1255341509 | 05 | |
| TN | 3706263 | 05 | |
| TN | DEPARTMENT OF LABOR | 622968600 | 01 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Family Medicine and Internal Medicine Johnson City | Other Name - Individual/Organization |
| MSMG FM IM 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 |
1021 W OAKLAND AVE SUITE 301 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-2191 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639160815 | James Richard Risney | Dermatology | 1021 W Oakland Ave, Suite 102, Johnson City, TN 37604-2191 | 2005-11-04 |
| 1508231572 | Appalachian Emergency Physicians | Emergency Medicine | 1021 W Oakland Ave, Suite 201, Johnson City, TN 37604-2191 | 2015-12-02 |
| 1013314384 | Samantha Manuel I | Nurse Practitioner | 1021 W Oakland Ave, Suite 301, Johnson City, TN 37604-2191 | 2014-12-02 |
| 1386902971 | Douglas Edema | Family Medicine | 1021 W Oakland Ave, Suite 207, Johnson City, TN 37604-2191 | 2012-05-02 |
| 1720269731 | Nerissa Licup | Internal Medicine | 1021 W Oakland Ave, Suite 301, Johnson City, TN 37604-2191 | 2007-11-19 |
| 1336335835 | Ambreen Adil Warsy | Family Medicine | 1021 W Oakland Ave, Suite 301, Johnson City, TN 37604-2191 | 2007-09-18 |
| 1306036041 | Mountain States Health Alliance | Personal Emergency Response Attendant | 1021 W Oakland Ave, Suite 310, Johnson City, TN 37604-2191 | 2007-07-30 |
| 1427163666 | The Regional Center for Oral & Maxillofacial Surgery, PC | Dentist | 1021 W Oakland Ave, Suite 109, Johnson City, TN 37604-2191 | 2006-08-20 |
| 1124043120 | Jeremy Nathan Elliott | Family Medicine | 1021 W Oakland Ave, Suite 301, Johnson City, TN 37604-2191 | 2006-07-12 |
| 1497719322 | Brittany M Cantrell | Physician Assistant | 1021 W Oakland Ave, Suite 301, Johnson City, TN 37604-2191 | 2006-04-17 |
| 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 | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154775468 | Luke Spencer | Family Medicine | 917 W. Walnut Street, Johnson City Family Medicine Center, Johnson City, TN 37604 | 2016-04-22 |
| 1184043853 | Shivali M Patel | Family Medicine | 400 N State of Franklin Rd Fl 4, Johnson City, TN 37604-6035 | 2014-04-10 |
| 1306062542 | Debra J. Uncapher | Family Medicine | 1409 W Market St Ste 108, Johnson City, TN 37604-6005 | 2007-04-17 |
| 1609947944 | Daniela Pogan Wright | Family Medicine | 401 East Main Strette, Johnson City, TN 37601-4877 | 2006-11-10 |
| 1518978402 | Vance Cleveland Shaw | Family Medicine | 205 High Point Dr, Johnson City, TN 37601-1503 | 2006-08-10 |
| 1871528976 | Boones Creek Medical Pllc | Family Medicine | 2685 Boones Creek Road, Suite 104, Johnson City, TN 37615 | 2006-07-11 |
| 1063459410 | State of Franklin Healthcare Associates Pllc | Family Medicine | 2528 Wesley St, Suite 2, Johnson City, TN 37601-1724 | 2006-06-01 |
| 1316995491 | Robert Elsworth Grindstaff | Family Medicine | 2203 Mckinley Rd, Ste 107, Johnson City, TN 37604-6893 | 2006-05-04 |
| 1184680787 | Paul E Moran IIi | Family Medicine | 1321 Sunset Dr, Suite 22, Johnson City, TN 37604-3698 | 2006-04-22 |
| 1295799120 | Guy W Robins | Family Medicine | 101 Med Tech Pkwy Ste 100, Johnson City, TN 37604-4006 | 2006-04-17 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on BLUE RIDGE MEDICAL MANAGEMENT CORPORATION.
| 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.