Fayette Community Hospital, Inc.
Organization Active NPI General Acute Care Hospital · Fayetteville, GA
NPI 1528027240 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1528027240
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 056-550 (GA)
- Legal business name
- FAYETTE COMMUNITY HOSPITAL, INC.
- Practice address
- 1255 Highway 54 W
Fayetteville, GA 30214-4526 - Phone
- (770) 719-7071
- Fax
- (770) 719-7092
- NPI assigned
- Mar 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Robert C Cross
- Title
- VP, Government Reimbursement
- Phone
- (470) 271-3401
Owners & managing parties with NPI records 7
-
Michael J Behr, M.D.
-
Dennis E Choat, MD
-
Matthew M Ralsten, M.D.
-
Geetha Shiva Rao, MD
-
Angela Swayne, MD
-
Mironda Williams, M.D.
Corporate family (same tax ID) 1
Member of 1
Member organizations 1
Facilities with the same owner 29
Practitioners 148
-
Mohammed M Abdu, MD
-
Imad Abossallue, M.D.
-
Frank Alena, M.D
-
Syed Ahad Ali, MD
-
Oyeyemi Kikelomo Amosu, M.D.
-
Ashlie Arthur, DO
-
Befikir Astil, M.D.
-
Kodjo Ayertey, MD
-
Tim W Baker, M.D.
-
David A Bakken, M.D.
-
David M Banks, MD
-
William Edwin Behm, M.D.
-
Martin G Belson, MD
-
Girma Tesfaye Beyene, M.D.
-
Joanne M Biafore, MD
-
Angella Elaine Brown, M.D.
-
Frank Brown, MD
Affiliated clinicians 931
-
Muhammad Abbasi, M.D.
-
John Thomas Abbott Jr., M.D.
-
Mohammed M Abdu, MD
-
Imad Abossallue, M.D.
-
Wasiu Femi Adisa, D.O.
-
Monica Christine Aerstin, NP-C
-
Shiv Kumar Agarwal, M.B.B.S., M.D.
-
Ali Ahmad, MD
-
Naveed Akhtar, MD
-
Folashade O Alade, M.D.
-
Mark J Albritton, M.D.
-
Frank Alena, M.D
-
Ashli Phillips Alexander, M.D.
-
Syed Ahad Ali, MD
-
Idi Allen, M.D.
-
Elizabeth Brass Almon, M.D.
-
Gregory Alvarez, DPM
Medicare Care Compare: Hospital
- Listed as
- Piedmont Fayette Hospital
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0932782 | Fayette Community Hospital Laboratory | Accreditation | Apr 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
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
- Corporation · Non-profit
- Incorporated
- Jun 4, 1997 in GA
- Enrollment address
- 1255 Highway 54 West
Fayetteville, GA 30214-4526 - Hospital subgroups
- General, Short-term
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Merry N Heath |
Operational/Managerial Control |
Dec 1, 2015 | |
| Thomas Arnold |
Operational/Managerial Control |
Mar 16, 2021 | |
| Michael J Mandl |
Corporate Director |
Aug 25, 2020 | |
| Mark E Gray |
Corporate Director |
Jul 1, 2021 | |
| Janet L Moon |
Corporate Director |
Jul 1, 2020 | |
| Mironda Denise Williams |
Corporate Director |
Jul 1, 2021 | |
| Matthew L Ramsey |
Corporate Director |
Jul 1, 2020 | |
| Piedmont Healthcare Inc |
5% Or Greater Direct Ownership Interest | Nov 6, 2007 | 100% |
| Operational/Managerial Control | Nov 6, 2007 | ||
| Robert R Reeves |
Corporate Director |
Jul 1, 2021 | |
| Robert C Cross |
W-2 Managing Employee |
Oct 17, 2013 | |
| Angela D Swayne |
Operational/Managerial Control |
Jan 1, 2019 | |
| Elizabeth Leddy |
Corporate Officer |
May 5, 2017 | |
| Stephen D Porter |
Corporate Officer |
Jun 24, 2019 | |
| Corporate Director |
Jul 1, 2021 | ||
| Kevin M Clark |
Operational/Managerial Control |
Apr 3, 2023 | |
| Dennis Choat |
Corporate Director |
Dec 1, 2022 | |
| Michael J Behr |
Corporate Director |
Jul 1, 2021 | |
| Matthew M Ralsten |
Corporate Director |
Jan 1, 2022 | |
| Scott a Wolfe |
Corporate Officer |
Sep 1, 2015 | |
| Geetha S Rao |
Corporate Director |
Jul 1, 2020 | |
| William M Scott |
Corporate Director |
Jul 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Fayette Community Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 056-550 | GA | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CG7492 | Other | GA | MEDICARE RAIL ROAD PART B |
| 00755323A | Medicaid | GA |
Other names
- Piedmont Fayette Hospital
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Fayetteville, GA
- Lindsey Bryant Fannin
- Mattie Mae Farmer Clark
- Shamarra Jackson Farmer
- Toniya Marie Farmer
- Fayette Care Clinic
- Fayette County Board of Health
- Fayette Dental Group PC
- Fayette Emergency Group LLC
- Fayette Eye Center PC
- Fayette Hearing Clinic Inc
All providers in Fayetteville, GA · General Acute Care Hospital in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.