NPIMap

Organization Active NPI

Coliseum Medical Center, LLC

  • Psychiatric Hospital Unit
  • Macon, GA
National Provider Identifier
1760436810
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
COLISEUM MEDICAL CENTER, LLC
Practice address
340 Hospital Drive
Macon, GA 31217
Phone
(478) 741-1355
Fax
(478) 742-1247
NPI assigned
May 22, 2006
Organization subpart
Yes
Parent organization
COLISEUM 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 Primary

Addresses

Primary practice location

340 Hospital Drive
Macon, GA 31217

Mailing address

340 Hospital Drive
Macon, GA 31217-3838
Phone (478) 741-1355

Other identifiers 2

IdentifierTypeStateIssuer
166206000OtherDEPT OF LABOR
3521OtherGABLUE CROSS

Other names 1

  • Piedmont Macon 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
O20150501000702 GA Part A Provider - Hospital 6406819572 Practice locations: Macon, GA

Hospital certification: CCN 11S164

Legal name
COLISEUM MEDICAL CENTER LLC
Doing business as
PIEDMONT MACON MEDICAL CENTER
Organization structure
LLCNon-profit
Enrollment address
350 Hospital Dr
Macon, GA 31217-3838
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
Coliseum Health System3 organizations share this tax ID, including this one
Part of
Coliseum Health System

Other organizations with this tax ID 2

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

Locations

340 Hospital Dr
Macon, GA 31217
Phone (478) 219-7735

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Thomas Arnold Individual Corporate OfficerCfo Aug 1, 2021
Michael J Mandl Individual Corporate Officer Aug 1, 2021
Piedmont Macon Hospital Inc Organization, Atlanta, GA Created for acquisition, Corporation, Holding company, Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2021 100%
Alisha R Neal Individual W-2 Managing EmployeeCfo Aug 1, 2021 100%
Piedmont Healthcare Inc Organization, Atlanta, GA Corporation, Non-profit Operational/Managerial Control Aug 1, 2021 100%
Robert C Cross Individual Corporate Officer Aug 1, 2021
Elizabeth Leddy Individual Corporate Officer Aug 1, 2021

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1760436810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 HOSPITAL DRIVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173838",
            "telephone_number": "478-741-1355",
            "fax_number": "478-742-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 HOSPITAL DRIVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31217",
            "telephone_number": "478-741-1355",
            "fax_number": "478-742-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLISEUM MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLISEUM MEDICAL CENTER, LLC",
        "enumeration_date": "2006-05-22",
        "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"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "166206000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3521",
            "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 Macon Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.