BLUE RIDGE ACADEMIC MEDICAL GROUP, PLC (NPI# 1861453078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861453078 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE ACADEMIC MEDICAL GROUP, PLC |
| Practice Address |
3700 S Main St Blacksburg VA 24060-7017 |
| Mailing Address |
2265 Kraft Dr Blacksburg VA 24060-6360 |
| Practice Telephone | 5409511111 |
| Mailing Telephone | 5408185891 |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ISAAC J KIRSTEIN (PHYSICIAN) |
| Authorized Official Telephone | 5408185890 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | 0102201473 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | RAILROAD MEDICARE | DA5070 | 01 |
| VA | ANTHEM | 279560 | 01 |
| Street Address |
3700 S MAIN ST |
| City | BLACKSBURG |
| State | VA |
| Zip Code | 24060-7017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629077128 | River Valley Pathology, Inc. | Pathology | 3700 S Main St, Blacksburg, VA 24060-7017 | 2005-07-18 |
| 1679100481 | Christopher M George | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-24 |
| 1285261776 | Deborah Lynn Enns | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-24 |
| 1053947960 | Jake Daniel Norris | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-23 |
| 1154958031 | Luke Godwin | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-23 |
| 1316574296 | Angel Manuel Vigo | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-23 |
| 1083240956 | Dennis K Adaaquah | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-23 |
| 1720614670 | Toni Young | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-22 |
| 1144856097 | Cameron Michael Ross | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-22 |
| 1306472303 | Marika Adrienne Pitot | Student in an Organized Health Care Education/Training Program | 3700 S Main St, Blacksburg, VA 24060-7017 | 2020-03-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144789215 | Center for Cognition, Language & Speech, LLC | Speech-Language Pathologist | 1999 South Main St., Suite 303, Blacksburg, VA 24060 | 2019-03-18 |
| 1669945465 | Hannah Jacqueline Lower | Physical Therapy Assistant | Kroontje Healthcare Center, 100 Litton Lane, Blacksburg, VA 24060 | 2019-01-04 |
| 1720568637 | Amy Butler | Nurse Practitioner | Blue Ridge Cancer Center, 2955 Research Drive, Blacksburg, VA 24060 | 2018-08-20 |
| 1134615321 | Benjamin Toliver Matthews | Dentist | 1400 S. Main St, Ste 1, Blacksburg, VA 24060 | 2018-07-10 |
| 1881107100 | New River Periodontics and Dental Implant Center, PC | Dentist | 2612 Sheffield Drive, Blacksburg, VA 24060 | 2017-11-08 |
| 1316333685 | Access and Mobility | Durable Medical Equipment & Medical Supplies | 2536 Blossom Trail West, Blackburg, VA 24060 | 2015-04-13 |
| 1326485202 | Kristopher Joel Hansen | Internal Medicine | 2600 Research Center Dr Ste A, Blacksburg, VA 24060 | 2013-05-31 |
| 1891038949 | Holly P. Martin | Physician Assistant | 3706 South Main Street, Suite D, Blacksburg, VA 24060 | 2013-03-27 |
| 1174875330 | Catawba Hospital | Chronic Disease Hospital | 1801 Glade Road, Blacksburg, VA 24060 | 2012-10-11 |
| 1083964316 | Karla Sue Soukup | Marriage & Family Therapist | 510 S. Main Street, Blackburg, VA 24060 | 2012-09-13 |
| Find all providers in zip 24060 | ||||
| Taxonomy Code | 204C00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neuromusculoskeletal Medicine, Sports Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740360114 | Alan Stockard PC | Neuromusculoskeletal Medicine, Sports Medicine | 101 Professional Park Dr Se, Suite 3, Blacksburg, VA 24060-6685 | 2006-10-17 |
| 1477633832 | Per Gunnar Brolinson | Neuromusculoskeletal Medicine, Sports Medicine | 101 Professional Park Dr Se, Suite 3, Blacksburg, VA 24060-6685 | 2006-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699846121 | Orthopaedic Associates of Virginia, Ltd | Neuromusculoskeletal Medicine, Sports Medicine | 953b West 21st St, Virginia Beach, VA 23517 | 2006-11-13 |
| 1003987819 | Orthopaedic Associates of Virginia, Ltd | Neuromusculoskeletal Medicine, Sports Medicine | 2020 General Booth Blvd, Suite 110, Virginia Beach, VA 23454-5875 | 2006-11-13 |
| 1386741742 | David Cole Wilson IIi | Neuromusculoskeletal Medicine, Sports Medicine | 1355 Richmond Rd., Staunton, VA 24402-4000 | 2006-09-20 |
| 1548367667 | Rebecca Webb Tanner | Neuromusculoskeletal Medicine, Sports Medicine | 4582 Franklin Rd Sw, Roanoke, VA 24014-5144 | 2006-09-20 |
| 1801991427 | Hopewell Orthopaedic Center, Inc | Neuromusculoskeletal Medicine, Sports Medicine | 2 E Hundred Rd, Chester, VA 23836-2609 | 2006-09-14 |
| 1750303962 | Stephen C Saddler | Neuromusculoskeletal Medicine, Sports Medicine | 8101 Hinson Farm Road, Suite 301, Alexandria, VA 22306 | 2006-07-24 |
| 1740255637 | Craig Ernest Bischoff | Neuromusculoskeletal Medicine, Sports Medicine | 620 John Paul Cirlce, Portsmouth, VA 23708-2197 | 2006-02-22 |
| 1558485474 | Tony Tsitos | Neuromusculoskeletal Medicine, Sports Medicine | 7501 Little River Tpke, Annandale, VA 22003-2923 | 2007-03-17 |
| 1770632606 | Neerada Rao | Neuromusculoskeletal Medicine, Sports Medicine | 1850 Cameron Glen Dr, Suite 600, Reston, VA 20190-3363 | 2007-01-09 |
| 1215099247 | Frederick Stephen Fogelson | Neuromusculoskeletal Medicine, Sports Medicine | 2221 Edward Holland Dr, Richmond, VA 23230-2518 | 2006-12-15 |
| Find all providers with the same taxonomy | ||||
| City | BLACKSBURG |
| Zip Code | 24060 |
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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.