NPIMap

Organization Active NPI

Paulding Medical Center, Inc.

Doing business as Wellstar Paulding Hospital

  • General Acute Care Hospital
  • Hiram, GA
National Provider Identifier
1457329435
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PAULDING MEDICAL CENTER, INC.
Doing business as
Wellstar Paulding Hospital
Practice address
2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone
(470) 644-7000
Fax
(470) 644-7399
NPI assigned
Mar 8, 2006
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Anthony J Budzinski
Title
Evp
Phone
(470) 644-0012

Specialties & licenses 1

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

Addresses

Primary practice location

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068

Mailing address

1800 Parkway PL SE Ste 500
Marietta, GA 30067-8237
Phone (470) 956-4981

Other identifiers 2

IdentifierTypeStateIssuer
00001438AMedicaidGA
100043OtherGABLUE CROSS

Other names 1

  • Wellstar Paulding Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080306000537 GA Part A Provider - Hospital 2163318965 Practice locations: Hiram, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457329435. Details of each certification follow.

Hospital certification: CCN 110042

Legal name
PAULDING MEDICAL CENTER, INC.
Doing business as
WELLSTAR PAULDING HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 19, 2024
Beds
83
Ownership / control type
Other
Most recent change of ownership
Aug 1, 1995 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 30, 1993 in GA
Enrollment address
2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Main/Primary Hospital Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Wellstar Paulding Medical CenterCCN 110042 · 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
No

National Provider Directory

National Provider Directory

Locations

11333 Sepulveda Blvd
Fl 2
Mission Hills, CA 91345
Phone (818) 869-7263

148 Bill Carruth Pkwy
Ste LL20
Hiram, GA 30141
Phone (770) 443-7700

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
William C Brock Individual Corporate DirectorBoard Member Jul 1, 2015 5%
Joseph a Reppert Individual Corporate OfficerSenior Vice President of Finance Apr 4, 2024 100%
W-2 Managing EmployeeSenior Vice President of Finance Aug 3, 2020 100%
Orrin S Swayze Individual Corporate DirectorBoard Member Jul 1, 2014 5%
John C McKibben Individual Corporate DirectorBoard Member Aug 1, 2019 5%
Hiram Speer Burdette Individual Corporate DirectorBoard Member Apr 1, 2016 5%
Keith Parker Individual Corporate DirectorBoard Member Jul 1, 2023 5%
Paul Lawrence Douglass Individual Corporate DirectorBoard Member Aug 22, 2016 5%
Mitzi Moore Individual Corporate DirectorBoard Member Apr 3, 2014 5%
Wellstar Health System Inc Organization, Marietta, GA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 30, 1993 100%
Operational/Managerial Control Dec 30, 1993
Gretchen Corbin Individual Corporate DirectorBoard Member Oct 3, 2024 5%
James Glen Cunningham Individual Corporate DirectorBoard Member Mar 4, 2021 5%
Ebenezer Erzuah Individual W-2 Managing EmployeeExecutive Director of Reimbursement Jul 20, 2009 100%
Mark Berry Individual Corporate DirectorBoard Member Oct 7, 2021 5%
James Holmes Individual Corporate DirectorBoard Member Apr 4, 2016 5%
Candice Saunders Individual Corporate OfficerPresident and Ceo Jul 1, 2015 100%
W-2 Managing EmployeePresident and Ceo Jul 1, 2015 100%
Edward Tate Individual Corporate DirectorBoard Member Nov 3, 2023 5%
James Swartz Individual Corporate OfficerVice President of Accounting Mar 2, 2010 100%
W-2 Managing EmployeeVice President of Accounting Mar 2, 2010 100%
Greg Morgan Individual Corporate DirectorBoard Member Jul 1, 2014 5%
James L Hornsby Individual Corporate DirectorBoard Member Jul 1, 2018 5%
Edward Richardson Individual Corporate DirectorBoard Member Apr 4, 2019 5%
David Bottoms Individual Corporate DirectorBoard Member Feb 2, 2023 5%
Frank Ros Individual Corporate DirectorBoard Member Mar 1, 2013

Owners & managing parties with NPI records 3

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

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 45

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 45

Affiliated clinicians 855

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

View all 855

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1457329435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 PARKWAY PL SE STE 500",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678237",
            "telephone_number": "470-956-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2518 JIMMY LEE SMITH PKWY",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412068",
            "telephone_number": "470-644-7000",
            "fax_number": "470-644-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULDING MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2024-06-27",
        "certification_date": "2022-05-12",
        "status": "A",
        "authorized_official_last_name": "BUDZINSKI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "470-644-0012"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00001438A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "100043",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wellstar Paulding Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellstar Paulding Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hiram, GA

Sources for this page

Verify at the official NPI Registry.