NPIMap

Organization Active NPI

Kennestone Hospital, Inc.

Doing business as Wellstar Windy Hill Hospital

  • Long Term Care Hospital
  • Marietta, GA
National Provider Identifier
1700853041
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
KENNESTONE HOSPITAL, INC.
Doing business as
Wellstar Windy Hill Hospital
Practice address
2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Phone
(470) 644-0012
NPI assigned
Mar 7, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Mr. Anthony J Budzinski
Title
Executive VP & Cfo
Phone
(470) 644-0012

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

2540 Windy Hill Rd SE
Marietta, GA 30067-8605

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
100096OtherGABLUE CROSS
00001999AMedicaidGA

Other names 1

  • Wellstar Windy Hill 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
O20101022000441 GA Part A Provider - Hospital 3870490816

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1700853041. Details of each certification follow.

Hospital certification: CCN 112007

Legal name
KENNESTONE HOSPITAL, INC.
Doing business as
WELLSTAR WINDY HILL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jul 1, 1997
Last certification
Oct 20, 2023
Beds
115
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 16, 1993 in GA
Enrollment address
2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Main/Primary Hospital Location
Hospital subgroups
Long-term

Hospital certification: CCN 110176

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PROMINA WINDY HILL HOSPITAL
Certification status
Terminated Other: provider status change, Jun 30, 1997
Provider type (POS)
Hospital – Short-term
Participating since
Jan 10, 1980
Last certification
Dec 10, 1990
Beds
115
Ownership / control type
Other
Most recent change of ownership
Mar 1, 1997 (2 total)
Facility address
2540 Windy Hill Rd
Marietta, GA 30067

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Wellstar Windy Hill HospitalCCN 112007 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Beds
115

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
11D0255256Wellstar Windy Hill Hospital2540 Windy Hill Road, Marietta, GA 30067AccreditationNov 30, 2027
11D0999119Wellstar Windy Hill Hospital Laboratory2540 Windy Hill Road, Marietta, GA 30067Certificate of waiverMay 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kennestone Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

3747 Roswell Rd
Marietta, GA 30062
Phone (470) 956-0250

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
William C Brock Individual Corporate DirectorBoard Member Jul 1, 2015 5%
Heather Graham Individual Corporate DirectorBoard Member Sep 1, 2025 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%
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 5% Or Greater Direct Ownership Interest Jul 1, 1997 100%
Operational/Managerial Control Jul 1, 1997
Gretchen Corbin Individual Corporate DirectorBoard Member Oct 3, 2024 5%
John Kerndl Individual Corporate OfficerEvp & Cfo Feb 17, 2025 100%
W-2 Managing EmployeeEvp & Cfo Feb 17, 2025 100%
James Glen Cunningham Individual Corporate DirectorBoard Member Mar 4, 2021 5%
Ebenezer Erzuah Individual W-2 Managing EmployeeExec Dir 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%
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 Aug 25, 2012 5%

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 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 1,308

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

View all 1,308

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1700853041",
    "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": "2540 WINDY HILL RD SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678605",
            "telephone_number": "470-644-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "BUDZINSKI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE VP & CFO",
        "authorized_official_telephone_number": "470-644-0012",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "100096",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00001999A",
            "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 Windy Hill Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellstar Windy Hill Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.