NPIMap

Organization Active NPI

Northside Hospital, Inc.

Doing business as Northside Hospital Duluth

  • General Acute Care Hospital
  • Duluth, GA
National Provider Identifier
1790715381
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
067-628 Issued in GA
Legal business name
NORTHSIDE HOSPITAL, INC.
Doing business as
Northside Hospital Duluth
Practice address
3620 Howell Ferry Rd
Duluth, GA 30096-3178
Phone
(678) 312-6800
NPI assigned
Jul 3, 2006
Last updated
Jun 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

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

Authorized official

Name
Amy E Fouts
Title
Chief Compliance Officer
Phone
(404) 851-6968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 067-628 GA Primary

Addresses

Primary practice location

3620 Howell Ferry Rd
Duluth, GA 30096-3178

Mailing address

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342-1606
Phone (404) 851-6378

Other identifiers 1

IdentifierTypeStateIssuer
1064AMedicaidGA

Other names 1

  • Northside Hospital Duluth Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040309000009 GA Part B Supplier - Clinic/Group Practice 8123916426 Receives reassigned benefits from 100 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceville, GA; Duluth, GA
O20210505001504 GA Part B Supplier - Clinic/Group Practice 4880003771 Receives reassigned benefits from 55 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Decatur, GA; Lawrenceville, GA; Johns Creek, GA; Loganville, GA; Macon, GA; Peachtree Corners, GA; Snellville, GA; Suwanee, GA…
O20210706002144 GA Part A Provider - Hospital 9830007236 Practice locations: Duluth, GA
O20210922003505 GA Part A Provider - Hospital 9830007236 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Duluth, GA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1790715381. Details of each certification follow.

Hospital certification: CCN 110252

Legal name
NORTHSIDE HOSPITAL INC
Doing business as
NORTHSIDE HOSPITAL DULUTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 2021
Last certification
Oct 25, 2024
Beds
122
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Incorporated
Sep 25, 1991 in GA
Enrollment address
3620 Howell Ferry Rd
Duluth, GA 30096-3178
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Rehabilitation unit

Hospital certification: CCN 11T252

Legal name
NORTHSIDE HOSPITAL INC
Organization structure
OtherNon-profit
Enrollment address
3215 McClure Bridge Rd
Duluth, GA 30096-3223
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Northside Hospital DuluthCCN 110252 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Northside Hospital DuluthCCN 11T252 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 2021

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
11D0256605Northside Hospital Duluth3620 Howell Ferry Road, Duluth, GA 30096AccreditationFeb 8, 2027
11D0901200Northside Hospital Duluth3620 Howell Ferry Road, Blood Gas Lab/Resp Care, Duluth, GA 30096AccreditationJan 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bluemark LLC Office Ally5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2098 Teron Trce
Ste 400500
Dacula, GA 30019
Phone (678) 722-3940

2108 Teron Trce
#100A
Dacula, GA 30019
Phone (678) 312-9120

3855 Pleasant Hill Rd
#S480
Duluth, GA 30096

3855 Pleasant Hill Rd
Ste 400
Duluth, GA 30096
Phone (678) 312-7440

1132 Athens Hwy
Ste 208210
Grayson, GA 30017
Phone (678) 312-8340

100 Medical Center Blvd
Ste 165
Lawrenceville, GA 30046
Phone (678) 312-2600

100 Medical Center Blvd
Ste 210
Lawrenceville, GA 30046
Phone (678) 312-6040

2200 Medical Center Blvd
Ste G1
Lawrenceville, GA 30046
Phone (404) 962-2500

500 Medical Center Blvd
Ste 130
Lawrenceville, GA 30046
Phone (470) 325-1530

500 Medical Center Blvd
Ste 180
Lawrenceville, GA 30046
Phone (770) 339-0039

500 Medical Center Blvd
Ste 31
Lawrenceville, GA 30046

500 Medical Center Blvd
Ste 50
Lawrenceville, GA 30046

665 Duluth Hwy
Lawrenceville, GA 30046
Phone (678) 312-0400

665 Duluth Hwy
Ste 401
Lawrenceville, GA 30046
Phone (678) 312-0450

755 Walther Rd
Ste 130
Lawrenceville, GA 30046
Phone (678) 328-1760

1608 Tree Ln
Bldg C
Snellville, GA 30078
Phone (678) 344-4472

1700 Tree Ln
Ste 490
Snellville, GA 30078
Phone (770) 963-4445

361 Delaware Ave
Buffalo, NY 14202

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
Keith Buchanan Individual Corporate DirectorBoard Member Aug 28, 2019
Corporate DirectorBoard Member Aug 8, 2019
Robert T. Quattrocchi Individual Corporate OfficerCeo Oct 28, 2004
Corporate DirectorBoard Member/Ceo Oct 28, 2004
Corporate DirectorCeo Oct 28, 2004
Thurbert Baker Individual Corporate DirectorBoard Member May 6, 2019
Wayne Sikes Individual Corporate DirectorBoard Member Aug 28, 2019
Alan K Carnes Individual Corporate DirectorBoard Member Aug 28, 2019
John Levengood Individual W-2 Managing Employee Aug 28, 2019
Shannon Banna Individual Corporate OfficerCfo Jan 1, 2018
W-2 Managing EmployeeCfo Jan 1, 2018
Anthony Salvatore Individual Corporate DirectorBoard Member May 1, 2005
Corporate DirectorBoard Memeber May 1, 2005
Iqbal Garcha Individual Corporate DirectorBoard Member Feb 1, 2016
Amy E Fouts Individual Corporate OfficerChief Compliance Officer Apr 1, 2026
W-2 Managing Employee Apr 1, 2026
Nicholas P Gubbins Individual Corporate OfficerDir., Process Improvement & Complia Apr 1, 2026
W-2 Managing Employee Apr 1, 2026
Corporate Officer Apr 1, 2026
Genevieve L Fairbrother Individual Corporate DirectorBoard Member Feb 1, 2016
Wayne Lee Ambroze Individual Corporate DirectorBoard Member Feb 1, 2016
Deborah S Mitcham Individual Corporate OfficerCeo of NHG & NHD Aug 29, 2019
Corporate Officer Jul 1, 2021
Josef G Venable Individual Corporate Director May 1, 2021
Barbara a Pare Individual Corporate DirectorBoard Member May 1, 2008
Corporate Director May 1, 2008
Mark J Sweeney Individual Corporate DirectorBoard Member May 1, 2006
Dale M Bearman Individual Corporate DirectorBoard Member Feb 1, 2007
Jorge J Hernandez Individual Corporate OfficerVice President Nov 19, 2007
W-2 Managing EmployeeVice President Nov 19, 2007
Terri Jondahl Individual Corporate DirectorBoard Member Aug 28, 2019

Owners & managing parties with NPI records 7

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
Northside Hospital ForsythCumming, GA, CCN 110005 Hospital 5% Or Greater Direct Ownership Interest Jul 25, 1991
Northside Hospital CherokeeCanton, GA, CCN 110008 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 25, 1991
Northside Hospital GwinnettLawrenceville, GA, CCN 110087 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 28, 2019

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 129

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 129

Affiliated clinicians 691

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

View all 691

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1790715381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FY RD NE",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-6378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 HOWELL FERRY RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963178",
            "telephone_number": "678-312-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A",
        "authorized_official_last_name": "FOUTS",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "404-851-6968"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "067-628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1064A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Northside Hospital Duluth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, GA

Sources for this page

Verify at the official NPI Registry.