BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1134500218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134500218 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | BALLAD HEALTH MEDICAL ASSOCIATES |
| Practice Address |
408 N State of Franklin Rd Suite 31c Johnson City TN 37604-6089 |
| Practice Telephone | 4234314946 |
| Practice Fax Number | 4234314947 |
| Mailing Telephone | 4234314946 |
| Mailing Fax Number | 4234314947 |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2019-03-28 |
| Authorized Official Name | MR. CARL STEVE KILGORE (PRESIDENT) |
| Authorized Official Telephone | 4233023051 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2080P0008X |
Pediatrics Specialization: Neurodevelopmental Disabilities |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1134500218 | 05 | |
| TN | Q013693 | 05 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Pediatric Neurology JC | Other Name - Individual/Organization |
| MSMG Pediatric Neurology | 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 |
408 N STATE OF FRANKLIN RD SUITE 31C |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-6089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710981105 | Thomas R. Borthwick | Internal Medicine | 408 N State of Franklin Rd, Suite 24, Johnson City, TN 37604-6089 | 2005-06-13 |
| 1013364785 | Jill Hughes | Nurse Practitioner | 408 N State of Franklin Rd, Suite 12, Johnson City, TN 37604-6089 | 2016-05-23 |
| 1245685858 | Blue Ridge Medical Management Corporaiton | Internal Medicine | 408 N State of Franklin Rd, Ste 12, Johnson City, TN 37604-6089 | 2016-05-02 |
| 1619349578 | Blue Ridge Medical Management Corporation | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31e, Johnson City, TN 37604-6089 | 2015-10-30 |
| 1679949572 | Julie Ann Reed | Nurse Practitioner | 408 N State of Franklin Rd, Suite 24, Johnson City, TN 37604-6089 | 2015-08-13 |
| 1962883678 | Blue Ridge Medical Management Corporation | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31b, Johnson City, TN 37604-6089 | 2015-06-18 |
| 1811378854 | Blue Ridge Medical Management Corporation | Pediatrics | 408 N State of Franklin Rd, Suite 31d, Johnson City, TN 37604-6089 | 2015-06-16 |
| 1336541259 | Brooklyn Beaupre | Nurse Practitioner | 408 N State of Franklin Rd, Suite 24, Johnson City, TN 37604-6089 | 2014-09-23 |
| 1063823185 | Alexis Hodge Duty | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31b, Johnson City, TN 37604-6089 | 2014-05-12 |
| 1316357593 | Blue Ridge Medical Management Corporation | Family Medicine | 408 N State of Franklin Rd, Suite 24 A, Johnson City, TN 37604-6089 | 2014-04-28 |
| 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 | 2080P0008X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neurodevelopmental Disabilities |
| A pediatrician who treats children having developmental delays or learning disorders including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134749526 | North Star Institute for Autism and Related Conditions | Pediatrics | 1138 N Germantown Pkwy Ste 101-120, Cordova, TN 38016-5872 | 2020-04-25 |
| 1821294331 | Alice Lawrence | Pediatrics | 2200 Childrens Way, 11101 Dot, Nashville, TN 37232-9003 | 2007-06-22 |
| 1528113602 | Tanjala Trinette Gipson | Pediatrics | 51 N Dunlap St Ste 400, Memphis, TN 38105-4625 | 2007-01-25 |
| 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.