NPIMap

Organization Active NPI

Piedmont Rockdale Hospital Inc.

  • General Acute Care Hospital
  • Conyers, GA
National Provider Identifier
1306355680
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PIEDMONT ROCKDALE HOSPITAL INC.
Practice address
1412 Milstead Ave NE
Conyers, GA 30012
Phone
(770) 918-3000
NPI assigned
Sep 29, 2017
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Mr. Robert C Cross
Title
VP Government Reimbursement
Phone
(470) 271-3401

Specialties & licenses 1

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

Addresses

Primary practice location

1412 Milstead Ave NE
Conyers, GA 30012

Mailing address

2727 Paces Ferry Rd SE Ste 2-920
Atlanta, GA 30339-4053
Phone (770) 918-3000

Other identifiers 2

IdentifierTypeStateIssuer
122-726MedicaidGA
000001603AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171018001408 GA Part A Provider - Hospital 0648546713 Practice locations: Conyers, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306355680. Details of each certification follow.

Hospital certification: CCN 110091

Legal name
PIEDMONT ROCKDALE HOSPITAL, INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 19, 2026
Beds
161
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2017 (3 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 2017 in GA
Enrollment address
1412 Milstead Ave NE
Conyers, GA 30012-3877
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Piedmont Rockdale HospitalCCN 110091 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member of 1

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

Locations

2727 Paces Ferry Rd SE
Ste 2920
Atlanta, GA 30339

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Thomas Arnold Individual Corporate OfficerVP Financial Operations Oct 1, 2017
Michael J Mandl Individual Corporate Officer Dec 1, 2022
Piedmont Healthcare Inc Organization, Atlanta, GA Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Oct 1, 2017 100%
Robert C Cross Individual Corporate OfficerVP Government Reimbursement Oct 1, 2017
Elizabeth Leddy Individual Corporate OfficerBoard Member Oct 1, 2017
Blakely D Watts Individual W-2 Managing EmployeeCeo Dec 1, 2021
Marvin Wynn Individual W-2 Managing EmployeeCfo Oct 1, 2017

Owners & managing parties with NPI records 1

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

Facilities with the same owner 29

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

View all 29

Practitioners & affiliated clinicians

Practitioners 41

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 41

Affiliated clinicians 438

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

View all 438

NPI Registry JSON

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1306355680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 PACES FERRY RD SE STE 2-920",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303394053",
            "telephone_number": "770-918-3000",
            "fax_number": "770-444-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 MILSTEAD AVE NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30012",
            "telephone_number": "770-918-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT ROCKDALE HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "CROSS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP GOVERNMENT REIMBURSEMENT",
        "authorized_official_telephone_number": "470-271-3401",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122-726",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001603A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.