NPIMap

Organization Active NPI

Eastside Medical Center, LLC

Doing business as Eastside Medical Center

  • Psychiatric Hospital Unit
  • Snellville, GA
National Provider Identifier
1467406413
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
EASTSIDE MEDICAL CENTER, LLC
Doing business as
Eastside Medical Center
Piedmont Eastside Medical Center
Practice address
2160 Fountain Dr
Snellville, GA 30078-7022
Phone
(770) 985-6473
Fax
(770) 736-3063
NPI assigned
May 22, 2006
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EASTSIDE MEDICAL CENTER, LLCAs reported in NPPES

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

Specialties & licenses 1

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

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 2

  • EASTSIDE MEDICAL CENTER Doing business as
  • Piedmont Eastside Medical Center Doing business as

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
O20070607000567 GA Part A Provider - Hospital 4183635972 Practice locations: Snellville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467406413. Details of each certification follow.

Hospital certification: CCN 11S192

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

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Eastside Medical Center LLC6 organizations share this tax ID, including this one
Part of
Eastside Medical Center LLC

Other organizations with this tax ID 5

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

Ownership & related parties

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 EmployeeCfo Aug 1, 2021
Thomas Arnold Individual Corporate Officer 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%

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

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1467406413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MEDICAL WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782195",
            "telephone_number": "770-979-0200",
            "fax_number": "770-736-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "770-985-6473",
            "fax_number": "770-736-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTSIDE MEDICAL CENTER, LLC",
        "enumeration_date": "2006-05-22",
        "last_updated": "2024-02-26",
        "certification_date": "2023-08-17",
        "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"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": [
        {
            "organization_name": "EASTSIDE MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Piedmont Eastside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Snellville, GA

Sources for this page

Verify at the official NPI Registry.