NPIMap

Organization Active NPI

Northeast Georgia Medical Center, Inc.

  • Psychiatric Hospital Unit
  • Gainesville, GA
National Provider Identifier
1437185261
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
NORTHEAST GEORGIA MEDICAL CENTER, INC.
Practice address
743 Spring St NE
Gainesville, GA 30501-3715
Phone
(770) 219-9000
Fax
(770) 219-6694
NPI assigned
Jun 23, 2006
Organization subpart
Yes
Parent organization
NORTHEAST GEORGIA MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Authorized official

Name
Brian D Steines
Title
Cfo
Phone
(770) 219-3562

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X GA Primary

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501-3715

Mailing address

PO Box 741891
Atlanta, GA 30374-1891
Phone (770) 219-9000

Other identifiers 1

IdentifierTypeStateIssuer
000000888AMedicaidGA

Other names 1

  • LAURELWOOD Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040422000903 GA Part B Supplier - Clinic/Group Practice 7517953755 Receives reassigned benefits from 61 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gainesville, GA
O20071113000428 GA Part A Provider - Hospital 7517953755 Practice locations: Gainesville, GA

Hospital certification: CCN 11S029

Legal name
NORTHEAST GEORGIA MEDICAL CENTER, INC.
Doing business as
LAURELWOOD
Organization structure
CorporationNon-profit
Incorporated
Nov 17, 1997 in GA
Enrollment address
200 Wisteria Dr
Gainesville, GA 30501-3827
Hospital Psychiatric Unit
Hospital subgroups
General, Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Northeast Ga Med Center11 organizations share this tax ID, including this one
Part of
Northeast Ga Med Center

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Alexander a. Wayne Individual Corporate Director Feb 1, 2014 100%
Steven F. Blair Individual Corporate Director Feb 1, 2014 100%
Ronald C Lewis Individual Corporate Director Feb 1, 2014 100%
Northeast Georgia Health System Organization, Gainesville, GA Operational/Managerial Control Sep 19, 2007
Lua R. Blankenship Individual Corporate Director Feb 1, 2014 100%
Brian D Steines Individual Corporate OfficerChief Financial Officer(Cfo) Jul 5, 2017 100%
W-2 Managing Employee Jul 5, 2017
Rodney Smith Individual Corporate Director Feb 1, 2014 100%
Robert P. Bowen Individual Corporate Director Feb 1, 2014 100%
Linda Nicholson Individual W-2 Managing Employee Sep 19, 2007
Larry E. Dent Individual Corporate Director Feb 1, 2014 100%
Carol Burrell Individual Corporate Director Sep 19, 2007
W-2 Managing Employee Sep 19, 2007
Jeffrey C Terry Individual Corporate Director Feb 1, 2014 100%
Jay S Hortenstine Individual Corporate Director Feb 1, 2014 100%
Timothy a Scully Individual Corporate Director Feb 1, 2014 100%
Kaye a. Hearth Individual Corporate Director Feb 1, 2014 100%
Jack B. Keener Individual Corporate Director Feb 1, 2014
Deborah K. Mack Individual Corporate Director Feb 1, 2014 100%
Anthony M. Herdener Individual Corporate Director Sep 19, 2007
W-2 Managing Employee Sep 19, 2007
Jane B. Smoot Individual Corporate Director Feb 1, 2014 100%
Jacquelyn L. Wallace Individual Corporate Director Feb 1, 2014 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Northeast Georgia Rehabilitation InstituteGainesville, GA, CCN 113039 Hospital 5% Or Greater Direct Ownership Interest (51%) Jun 3, 2025
New Horizons Lanier ParkGainesville, GA, CCN 115487 Skilled nursing facility Operational/Managerial Control (100%) Feb 4, 2008

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1437185261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741891",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741891",
            "telephone_number": "770-219-9000",
            "fax_number": "770-219-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013715",
            "telephone_number": "770-219-9000",
            "fax_number": "770-219-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST GEORGIA MEDICAL CENTER, INC.",
        "enumeration_date": "2006-06-23",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "STEINES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-219-3562"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000888A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAURELWOOD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "LAURELWOOD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.