BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1386028215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386028215 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | BALLAD HEALTH MEDICAL ASSOCIATES |
| Practice Address |
400 N State of Franklin Rd Office of Niswonger Ceo Johnson City TN 37604-6035 |
| Practice Telephone | 4234314847 |
| Practice Fax Number | 4234313949 |
| Mailing Telephone | 4234314847 |
| Mailing Fax Number | 4234313949 |
| Enumeration Date | 2015-07-09 |
| 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 |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1386028215 | 05 | |
| VA | 1386028215 | 05 | |
| TN | Q013912 | 05 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Pediatric Hospitalists NSCH | Other Name - Individual/Organization |
| MSMG Hospital Pediatrics NSCH | 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 |
400 N STATE OF FRANKLIN RD OFFICE OF NISWONGER CEO |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-6035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750389540 | Ian A Darling | Anesthesiology | 400 N State of Franklin Rd, Johnson City, TN 37604 | 2005-07-14 |
| 1174141691 | Roman Brudnik | Student in an Organized Health Care Education/Training Program | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2020-07-10 |
| 1811510993 | Susan Cronier | Nurse Anesthetist, Certified Registered | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2020-05-22 |
| 1033731823 | Krista Michelle Bonney | Student in an Organized Health Care Education/Training Program | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2020-05-14 |
| 1235760422 | William James Brant | Nurse Anesthetist, Certified Registered | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2020-01-28 |
| 1346881588 | Johnathan Seth Greene | Registered Nurse | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2019-09-30 |
| 1184285629 | Juliette Rita-marie Marchant | Nurse Practitioner | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2019-06-25 |
| 1629638671 | Akshit Griwan | Student in an Organized Health Care Education/Training Program | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2019-06-20 |
| 1891355053 | Lalith Vardhan Choudhary Namburu | Student in an Organized Health Care Education/Training Program | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2019-06-19 |
| 1932768173 | Natasha Khan | Student in an Organized Health Care Education/Training Program | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2019-06-11 |
| 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 | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922453190 | Rachel Michelle Lindsey | Pediatrics | 325 N State of Franklin Rd, Ground Floor, Etsu Physicians and Associates Pediatrics, Johnson City, TN 37604-6056 | 2016-04-25 |
| 1609261197 | Lauren Nichols Swift | Pediatrics | 325 N. State of Franklin Road, Ground Floor, Johnson City, TN 37604 | 2015-04-01 |
| 1437579760 | Daniel P Armentrout | Pediatrics | 301 Med Tech Pkwy Ste 160, Johnson City, TN 37604 | 2014-04-25 |
| 1225309891 | Medical Education Assistance Corporation | Pediatrics | 201 E Myrtle Ave, Johnson City, TN 37601 | 2012-01-13 |
| 1558673434 | Himabindu Kasivajjula | Pediatrics | 639 Main Street, Johnson City, NY 13790 | 2010-07-08 |
| 1558428037 | Beth W Hapke | Pediatrics | 512 Reynolds Rd, Apt K12, Johnson City, NY 13790-1366 | 2007-01-03 |
| 1750461265 | Shasta B Helsel | Pediatrics | 301 Med Tech Pkwy Ste 180, Johnson City, TN 37604 | 2006-10-17 |
| 1497738041 | Samuel Boi Addo | Pediatrics | 269 Riverside Dr, Johnson City, NY 13790-2726 | 2005-11-28 |
| 1831184266 | Otto H.p. Teixeira | Pediatrics | 325 N State of Franklin Rd., Ground Floor, Johnson City, TN 37604-6062 | 2005-09-12 |
| 1083619118 | Jodi B Gage | Pediatrics | 325 N. State of Franklin Road, Ground Floor, Johnson City, TN 37604 | 2005-06-16 |
| 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.