BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION — NPI 1417683095 (Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician) in BIG STONE GAP, VA)

CMS-1500 Box 24J / 33a • NPI

1417683095

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

2084P0800X (CMS 26)

Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)

Box 32 Service Location & ZIP+4

1980 HOLTON AVE E STE 103, BIG STONE GAP, VA, 24219-3367

✓ 9-Digit EDI 837 ZIP+4 (24219-3367)

Practice Phone & Referral Fax

(423) 302-3480

Fax: (423) 722-3009

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417683095 (BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417683095` (NPI-2 Organization / Facility)
Provider / Legal Name	BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Plain-English Specialty	Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician) NUCC Code: `2084P0800X` (Psychiatry & Neurology, Psychiatry)
Certifying / Licensing Body	American Board of Psychiatry and Neurology (ABPN)
Practice Location Address	1980 HOLTON AVE E STE 103, BIG STONE GAP, VA, 24219-3367
Practice Telephone / Fax	Tel: (423) 302-3480 \| Fax: (423) 722-3009
Administrative Mailing Address	509 MED TECH PKWY STE 100, JOHNSON CITY, TN, 37604-2579
Enumeration & Last Sync	Enumerated: 2022-07-27 \| CMS Record Updated: 2023-06-30
Authorized Official	PATRICIA TARTE (Enrollment)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1980 HOLTON AVE E STE 103, BIG STONE GAP, VA, 24219-3367

🗺️ Open in Google Maps 🏥 More Providers in BIG STONE GAP

🔒 Are you BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (2084P0800X)

What Does Taxonomy Code 2084P0800X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2084P0800X translates to:
"Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 26 (Physician/Psychiatry) • CMS Code 86 (Physician/Neuropsychiatry)
Certifying / Accrediting Authority: American Board of Psychiatry and Neurology (ABPN)
Clinical Scope: Depression, generalized anxiety, panic attacks, insomnia, bipolar disorder, OCD, PTSD, or medical recovery from substance dependence.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION)

Typical CPT / Diagnostic Procedures:

Comprehensive Psychiatric Diagnostic Evaluation (CPT 90792)
Psychopharmacological Management & Supportive Psychotherapy
Medication-Assisted Treatment (MAT) for Substance Use Disorders

Common Therapeutic Classes:

SSRIs & SNRIs (Sertraline, Escitalopram, Fluoxetine, Duloxetine)
Bupropion, Mirtazapine & Atypical Antipsychotics (Aripiprazole, Quetiapine)
Buprenorphine/Naloxone & Naltrexone (Addiction Recovery)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2084P0800X` — Psychiatry & Neurology, Psychiatry Plain English: Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION (NPI #1417683095)