NPIMap

Organization Active NPI

Northside Hospital, Inc.

Doing business as Northside Hospital Cherokee

  • General Acute Care Hospital
  • Canton, GA
National Provider Identifier
1225050396
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
028552 Issued in GA
Legal business name
NORTHSIDE HOSPITAL, INC.
Doing business as
Northside Hospital Cherokee
Practice address
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone
(770) 224-1000
NPI assigned
Jul 24, 2006
Last updated
Jun 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy E Fouts
Title
Chief Compliance Officer
Phone
(404) 851-6968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 028552 GA Primary

Addresses

Primary practice location

450 Northside Cherokee Blvd
Canton, GA 30115-8015

Mailing address

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342-1606
Phone (404) 851-1000

Other names 1

  • Northside Hospital Cherokee Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101025001193 GA Part A Provider - Hospital 9830007236 Practice locations: Woodstock, GA; Jasper, GA; Holly Springs, GA; Canton, GA
O20210505001504 GA Part B Supplier - Clinic/Group Practice 4880003771 Receives reassigned benefits from 55 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Decatur, GA; Lawrenceville, GA; Johns Creek, GA; Loganville, GA; Macon, GA; Peachtree Corners, GA; Snellville, GA; Suwanee, GA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225050396. Details of each certification follow.

Hospital certification: CCN 110008

Legal name
NORTHSIDE HOSPITAL INC
Doing business as
NORTHSIDE HOSPITAL CHEROKEE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 11, 2024
Beds
84
Ownership / control type
Other
Most recent change of ownership
Jan 1, 2010 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 25, 1991 in GA
Enrollment address
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Northside Hospital CherokeeCCN 110008 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Bluemark LLC Office Ally5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

450 Northside Cherokee Blvd
Ste 145
Canton, GA 30115

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Keith Buchanan Individual Corporate DirectorBoard Member Aug 28, 2019
Jorge J Hernandez Individual Corporate OfficerVice President Jan 1, 2018
W-2 Managing EmployeeVice President Dec 7, 2009
Robert T. Quattrocchi Individual Corporate OfficerCeo Oct 8, 2004
Corporate DirectorBoard Member, Ceo May 1, 2004
Thurbert Baker Individual Corporate DirectorBoard Member May 6, 2019
Wayne Sikes Individual Corporate DirectorBoard Member Aug 28, 2019
Terri Jondahl Individual Corporate DirectorBoard Member Aug 28, 2019
Alan K Carnes Individual Corporate DirectorBoard Member Aug 28, 2019
John Levengood Individual Corporate DirectorBoard Member Aug 28, 2019
Shannon Banna Individual Corporate OfficerCfo Jan 1, 2018
W-2 Managing EmployeeCfo Jan 1, 2018
William Hayes Individual W-2 Managing EmployeeHospital Ceo- Northside Cherokee Dec 7, 2009
Anthony Salvatore Individual Corporate DirectorBoard Member May 1, 2005
Iqbal Garcha Individual Corporate DirectorBoard Member May 1, 2016
Amy E Fouts Individual Corporate OfficerChief Compliance Officer Apr 1, 2026
W-2 Managing EmployeeChief Compliance Officer Apr 1, 2026
Nicholas P Gubbins Individual Corporate OfficerDir., Process Improvement & Complia Apr 1, 2026
W-2 Managing Employee Apr 1, 2026
Genevieve L Fairbrother Individual Corporate DirectorBoard Member Feb 2, 2013
Wayne Lee Ambroze Individual Corporate DirectorBoard Member May 1, 2016
Josef G Venable Individual Corporate DirectorBoard Member May 1, 2021
Barbara a Pare Individual Corporate DirectorBoard Member May 8, 2008
Mark J Sweeney Individual Corporate DirectorBoard Member May 1, 2006
Northside Hospital Inc Organization, Atlanta, GA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 25, 1991 100%
Dale M Bearman Individual Corporate DirectorBoard Member Feb 1, 2007

Owners & managing parties with NPI records 18

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 18

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northside Hospital ForsythCumming, GA, CCN 110005 Hospital 5% Or Greater Direct Ownership Interest Jul 25, 1991
Northside Hospital GwinnettLawrenceville, GA, CCN 110087 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 28, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 71

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 71

Affiliated clinicians 1,228

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,228

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1225050396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NORTHSIDE CHEROKEE BLVD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158015",
            "telephone_number": "770-224-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A",
        "authorized_official_last_name": "FOUTS",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "404-851-6968"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "028552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Northside Hospital Cherokee",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northside Hospital Cherokee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.