NPIMap

Organization Active NPI

Northside Hospital, Inc.

Doing business as Northside Hospital Forsyth

  • General Acute Care Hospital
  • Cumming, GA
National Provider Identifier
1376574277
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
058604 Issued in GA
Legal business name
NORTHSIDE HOSPITAL, INC.
Doing business as
Northside Hospital Forsyth
Practice address
1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone
(404) 851-8000
NPI assigned
Jul 6, 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 058604 GA Primary

Addresses

Primary practice location

1200 Northside Forsyth Dr
Cumming, GA 30041-7659

Mailing address

1200 Northside Forsyth Dr
Cumming, GA 30041-7659

Other names 1

  • Northside Hospital Forsyth 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 GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20021108000000 GA Part A Provider - Hospital 9830007236 Practice locations: Buford, GA; Snellville, GA; Johns Creek, GA; Gainesville, GA; Dawsonville, GA; Cumming, GA
O20111026000375 GA DME Supplier - Hospital 9830007236 Practice locations: Cumming, 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 1376574277. Details of each certification follow.

Hospital certification: CCN 110005

Legal name
NORTHSIDE HOSPITAL INC
Doing business as
NORTHSIDE HOSPITAL FORSYTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 25, 2024
Beds
389
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2002 (6 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 25, 1991 in GA
Enrollment address
1200 Northside Forsyth Drive
Cumming, GA 30041-7659
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Short-term

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 ForsythCCN 110005 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
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.

Locations

11975 Morris Rd
Ste 130
Alpharetta, GA 30005
Phone (770) 667-4240

1001 Summit Blvd
Ste 1000
Brookhaven, GA 30319

790 Church St NE
Ste 155
Marietta, GA 30060

1100 Johnson Fy Rd NE
Ste 190
Sandy Springs, GA 30342
Phone (404) 419-9970

2874 N Carson St
Ste 120
Carson City, NV 89706
Phone (775) 445-5181

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 Director Aug 28, 2019
Jorge J Hernandez Individual Corporate OfficerVP Admin Services/Cco Jan 1, 2018
W-2 Managing Employee Nov 19, 2007
Robert T. Quattrocchi Individual Corporate Officer Oct 28, 2004
Corporate Director Nov 8, 2002
W-2 Managing Employee Nov 8, 2002
Thurbert Baker Individual Corporate Director May 6, 2019
Wayne Sikes Individual Corporate Director Aug 28, 2019
Terri Jondahl Individual Corporate Director Aug 28, 2019
Alan K Carnes Individual Corporate Director Aug 28, 2019
John Levengood Individual Corporate Director Aug 28, 2019
Shannon Banna Individual Corporate OfficerCfo Jan 1, 2018
W-2 Managing EmployeeCfo Jan 1, 2018
William Hasty Individual Corporate Director Aug 1, 2009
Anthony Salvatore Individual Corporate Director Nov 19, 2007
Clyde N Davis Individual Corporate Director Aug 28, 2019
Iqbal Garcha Individual Corporate Director May 1, 2016
Genevieve L Fairbrother Individual Corporate Director Feb 2, 2013
Wayne Lee Ambroze Individual Corporate Director May 1, 2016
Josef G Venable Individual Corporate Director May 1, 2021
Lynn a Jackson Individual Corporate Officer Oct 6, 2023
W-2 Managing EmployeeCeo & VP of Administration Oct 6, 2023
Barbara a Pare Individual Corporate Director Apr 14, 2009
Mark J Sweeney Individual Corporate Director Nov 19, 2007
Northside Hospital Inc Organization, Atlanta, GA Non-profit 5% Or Greater Direct Ownership Interest Jul 25, 1991
Dale M Bearman Individual Corporate Director Nov 19, 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 CherokeeCanton, GA, CCN 110008 Hospital 5% Or Greater Direct Ownership Interest (100%) 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 1,526

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

View all 1,526

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1376574277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NORTHSIDE FORSYTH DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NORTHSIDE FORSYTH DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417659",
            "telephone_number": "404-851-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "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": "058604",
            "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 Forsyth",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northside Hospital Forsyth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.