NPIMap

Organization Active NPI

Hospital Authority of Wilkes County

Doing business as Wills Memorial Hospital

  • Critical Access Hospital
  • Washington, GA
National Provider Identifier
1619961695
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
157-200 Issued in GA
Legal business name
HOSPITAL AUTHORITY OF WILKES COUNTY
Doing business as
Wills Memorial Hospital
Practice address
120 Gordon St
Washington, GA 30673-1602
Phone
(706) 678-2151
Fax
(706) 678-1546
NPI assigned
Sep 7, 2005
Last updated
Feb 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Authorized official

Name
Tracie Burriss
Title
Cfo
Phone
(706) 678-9213

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 157-200 GA Primary

Addresses

Primary practice location

120 Gordon St
Washington, GA 30673-1602

Mailing address

120 Gordon St
Washington, GA 30673-1602
Phone (706) 678-2151

Other identifiers 2

IdentifierTypeStateIssuer
00002087SOtherGAMEDICAID SWING BED
00002087AMedicaidGA

Other names 1

  • Wills Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040611000522 GA Part B Supplier - Clinic/Group Practice 8628051489 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lincolnton, GA; Washington, GA
O20080228000517 GA Part A Provider - Critical Access Hospital 8628051489 Practice locations: Washington, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619961695. Details of each certification follow.

Hospital certification: CCN 111325

Legal name
HOSPITAL AUTHORITY OF WILKES COUNTY
Doing business as
WILLS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2002
Last certification
May 31, 2025
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
120 Gordon Street
Washington, GA 30673-0370
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Wills Memorial HospitalCCN 111325 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Gulati Nidhi MD2 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.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tracie Haughey Individual Operational/Managerial ControlCeo Jun 21, 2021 100%
Hospital Authority of Wilkes County Organization, Washington, GA Operational/Managerial Control Jun 21, 2021 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Wills Memorial HospitalWashington, GA, CCN 11Z325 Hospital Operational/Managerial Control (100%) Feb 1, 2016
Community Medical Associates of LincolntonLincolnton, GA, CCN 118533 Rural health clinic Operational/Managerial Control (100%) Feb 8, 2010
Community Medical Associates of WashingtonWashington, GA, CCN 118536 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2010

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 3

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.

Affiliated clinicians 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1619961695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 GORDON ST",
            "city": "WASHINGTON",
            "state": "GA",
            "postal_code": "306731602",
            "telephone_number": "706-678-2151",
            "fax_number": "706-678-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GORDON ST",
            "city": "WASHINGTON",
            "state": "GA",
            "postal_code": "306731602",
            "telephone_number": "706-678-2151",
            "fax_number": "706-678-1546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF WILKES COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "BURRISS",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "706-678-9213"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "GA",
            "license": "157-200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID SWING BED",
            "identifier": "00002087S",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00002087A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wills Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, GA

Sources for this page

Verify at the official NPI Registry.