NPIMap

Eastside Medical Center, LLC

Organization Active NPI Rehabilitation Hospital Unit · Snellville, GA

NPI 1376597328 · NPPES record last updated Feb 26, 2024

Key facts

NPI
1376597328
Entity type
Organization (NPI type 2)
Primary specialty
Rehabilitation Hospital Unit 273Y00000X
Legal business name
EASTSIDE MEDICAL CENTER, LLC
Practice address
2160 Fountain Dr
Snellville, GA 30078-7022
Phone
(770) 985-3885
Fax
(770) 985-3890
NPI assigned
May 22, 2006
Organization subpart
Yes
Parent organization (as reported)
EASTSIDE MEDICAL CENTER, LLC

Authorized official

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

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 5

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 29

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

View all 29

Affiliated clinicians 1

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

Medicare Care Compare: Inpatient rehabilitation facility

Listed as
Piedmont Eastside Medical Center CCN 11T192
Ownership
For profit
Certified
Sep 1, 2005

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Hospital certification: CCN 11T192

Legal name
EASTSIDE MEDICAL CENTER LLC
Doing business as
PIEDMONT EASTSIDE MEDICAL CENTER
Organization structure
LLC · Non-profit
Enrollment address
2160 Fountain Dr
Snellville, GA 30078-7022
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Amy N Wheeler
Individual 		W-2 Managing Employee
Cfo		 Aug 1, 2021
Thomas Arnold
Individual 		Corporate Officer
Cfo		 Aug 1, 2021
Michael J Mandl
Individual 		Corporate Officer Aug 1, 2021
Piedmont Healthcare Inc
Organization · Atlanta, GA
Corporation, Chain home office 		Operational/Managerial Control Aug 1, 2021 100%
Richard T Lind
Individual 		W-2 Managing Employee Aug 1, 2021
Robert C Cross
Individual 		Corporate Officer Aug 1, 2021
Elizabeth Leddy
Individual 		Corporate Officer Aug 1, 2021
Piedmont Eastside Hospital Inc
Organization · Atlanta, GA
Created for acquisition, Corporation, Holding company, Non-profit 		5% Or Greater Direct Ownership Interest Aug 1, 2021 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070607000631 GA Part a Provider - Hospital 4183635972 Practice locations: Snellville, GA

National Provider Directory

Tax ID family
Ehca Eastside LLC (6 organizations share this tax ID)
Part of
Ehca Eastside LLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Yes

Addresses

Primary practice location

2160 Fountain Dr
Snellville, GA 30078-7022

Mailing address

1700 Medical Way
Snellville, GA 30078-2195
Phone (770) 979-0200

Other names

  • Piedmont Eastside Medical Center Doing business as

Electronic endpoints

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

Other providers in Snellville, GA

All providers in Snellville, GA · Rehabilitation Hospital Unit in Georgia

Sources for this page

Verify at the official NPI Registry.