BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1003152307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003152307 |
| 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 120 Johnson City TN 37604-6971 |
| Practice Telephone | 4234312350 |
| Practice Fax Number | 4234312372 |
| Mailing Telephone | 4234312350 |
| Mailing Fax Number | 4234312372 |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2019-03-28 |
| Authorized Official Name | CARL STEVEN KILGORE (PRESIDENT / CEO) |
| Authorized Official Telephone | 4233023051 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | DEPARTMENT OF LABOR/FECA | 020487821 | 01 |
| VA | 1003152370 | 05 | |
| TN | DEPARTMENT OF LABOR/BLACK LUNG & ENERGY | 020487821 | 01 |
| TN | Q002409 | 05 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Neurosurgery and Spine JC | Other Name - Individual/Organization |
| MSMG NEUROSURG 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 120 |
| 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 |
| 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 |
| 1093016024 | Blue Ridge Medical Management Corporation | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2010-11-08 |
| 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 | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922085497 | Saeed Bajwa | Neurological Surgery | 46 Harrison St, Johnson City, NY 13790 | 2005-12-27 |
| 1073870945 | Vikas Patel | Neurological Surgery | 30 Harrison St Ste 400, Johnson City, NY 13790-2176 | 2012-04-17 |
| 1750518544 | Selma Kominek | Neurological Surgery | 701 Med Tech Pkwy, Suite 300, Johnson City, TN 37604-2365 | 2009-06-18 |
| 1629088364 | Timothy Michael Fullagar | Neurological Surgery | 701 Med Tech Pkwy, Suite 300, Johnson City, TN 37604-2365 | 2006-08-08 |
| 1073555934 | Blue Ridge Medical Management Corporation | Neurological Surgery | 408 N State of Franklin Rd, Suite 42, Johnson City, TN 37604-6089 | 2006-06-12 |
| 1528009198 | Scott C Dulebohn | Neurological Surgery | 410 N State of Franklin Rd, Suite 120, Johnson City, TN 37604-6971 | 2006-06-08 |
| 1770549453 | Steven C Hamel | Neurological Surgery | 408 N State of Franklin Rd, Suite 42, Johnson City, TN 37604-6089 | 2006-04-22 |
| 1053374835 | Barry J Pollack | Neurological Surgery | 46 Harrison St, Johnson City, NY 13790-2120 | 2006-04-11 |
| 1700863123 | Daniel D Galyon | Neurological Surgery | 46 Harrison St, Johnson City, NY 13790-2142 | 2005-12-28 |
| 1699752048 | Khalid Sethi | Neurological Surgery | 46 Harrison St, Johnson City, NY 13790-2142 | 2005-12-28 |
| Find all providers in JOHNSON CITY | ||||
| 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.