NPIMap

Organization Active NPI

Fayette Community Hospital, Inc.

Doing business as Piedmont Fayette Hospital

  • General Acute Care Hospital
  • Fayetteville, GA
National Provider Identifier
1528027240
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
056-550 Issued in GA
Legal business name
FAYETTE COMMUNITY HOSPITAL, INC.
Doing business as
Piedmont Fayette Hospital
Practice address
1255 Highway 54 W
Fayetteville, GA 30214-4526
Phone
(770) 719-7071
Fax
(770) 719-7092
NPI assigned
Mar 21, 2006
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 056-550 GA Primary

Addresses

Primary practice location

1255 Highway 54 W
Fayetteville, GA 30214-4526

Mailing address

1255 Highway 54 W
Patient Financial Services
Fayetteville, GA 30214-4526
Phone (770) 719-7071

Other identifiers 2

IdentifierTypeStateIssuer
00755323AMedicaidGA
CG7492OtherGAMEDICARE RAIL ROAD PART B

Other names 1

  • Piedmont Fayette Hospital 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 GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000205 GA Part B Supplier - Clinic/Group Practice 7416858360 Receives reassigned benefits from 1 practitioner
Practice locations: Fayetteville, GA
O20080307000576 GA Part A Provider - Hospital 7416858360 Practice locations: Fayetteville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528027240. Details of each certification follow.

Hospital certification: CCN 110215

Legal name
FAYETTE COMMUNITY HOSPITAL, INC.
Doing business as
PIEDMONT FAYETTE HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 23, 1997
Last certification
Mar 19, 2026
Beds
282
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 4, 1997 in GA
Enrollment address
1255 Highway 54 West
Fayetteville, GA 30214-4526
Main/Primary Hospital Location
Hospital subgroups
General, Short-term

Care Compare: Hospital

Medicare Care Compare
Listed as
Piedmont Fayette HospitalCCN 110215 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0932782Fayette Community Hospital Laboratory1255 Highway 54 West, Fayetteville, GA 30214AccreditationApr 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
Fayette Community Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization 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
Merry N Heath Individual Operational/Managerial ControlChief Nursing Officer Dec 1, 2015
Thomas Arnold Individual Operational/Managerial ControlChief Financial Officer, PHC Mar 16, 2021
Michael J Mandl Individual Corporate DirectorDirector Aug 25, 2020
Mark E Gray Individual Corporate DirectorDirector Jul 1, 2021
Janet L Moon Individual Corporate DirectorDirector Jul 1, 2020
Mironda Denise Williams Individual Corporate DirectorDirector Jul 1, 2021
Matthew L Ramsey Individual Corporate DirectorDirector Jul 1, 2020
Piedmont Healthcare Inc Organization, Atlanta, GA Chain home office 5% Or Greater Direct Ownership Interest Nov 6, 2007 100%
Operational/Managerial Control Nov 6, 2007
Robert R Reeves Individual Corporate DirectorDirector Jul 1, 2021
Robert C Cross Individual W-2 Managing EmployeeVP Government Reimbursement Oct 17, 2013
Angela D Swayne Individual Operational/Managerial ControlChief Medical Officer Jan 1, 2019
Elizabeth Leddy Individual Corporate OfficerSecretary May 5, 2017
Stephen D Porter Individual Corporate OfficerChief Executive Officer Jun 24, 2019
Corporate DirectorChairman, Board of Directors Jul 1, 2021
Kevin M Clark Individual Operational/Managerial ControlChief Operating Officer Apr 3, 2023
Dennis Choat Individual Corporate DirectorDirector Dec 1, 2022
Michael J Behr Individual Corporate DirectorDirector Jul 1, 2021
Matthew M Ralsten Individual Corporate DirectorDirector Jan 1, 2022
Scott a Wolfe Individual Corporate OfficerChief Financial Officer Sep 1, 2015
Geetha S Rao Individual Corporate DirectorDirector Jul 1, 2020
William M Scott Individual Corporate DirectorDirector Jul 1, 2020

Owners & managing parties with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 148

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 148

Affiliated clinicians 931

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

View all 931

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1528027240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "address_2": "PATIENT FINANCIAL SERVICES",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "770-719-7071",
            "fax_number": "770-719-7092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "770-719-7071",
            "fax_number": "770-719-7092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "056-550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00755323A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD PART B",
            "identifier": "CG7492",
            "state": "GA"
        }
    ],
    "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": "Piedmont Fayette Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Piedmont Fayette Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.