NPIMap

Organization Active NPI

West Georgia Medical Center, Inc.

Doing business as WellStar West Georgia Medical Center

  • General Acute Care Hospital
  • Lagrange, GA
National Provider Identifier
1821221144
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
WEST GEORGIA MEDICAL CENTER, INC.
Doing business as
WellStar West Georgia Medical Center
West Georgia Medical Center
Practice address
1514 Vernon Rd
Lagrange, GA 30240-4131
Phone
(706) 882-1411
Fax
(706) 845-8918
NPI assigned
Sep 3, 2009
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
Evp
Phone
(470) 644-0012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

1514 Vernon Rd
Lagrange, GA 30240-4131

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00002065AMedicaidGA

Other names 2

  • WellStar West Georgia Medical Center Doing business as
  • West Georgia Medical Center 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 GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091028000435 GA Part A Provider - Hospital 9335286160 Practice locations: Lagrange, GA
O20091207000333 GA Part B Supplier - Clinic/Group Practice 9335286160 Receives reassigned benefits from 2 practitioners
3 other NPIs on this enrollment
Practice locations: Lagrange, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821221144. Details of each certification follow.

Hospital certification: CCN 110016

Legal name
WEST GEORGIA MEDICAL CENTER, INC
Doing business as
WELLSTAR WEST GEORGIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 31, 2023
Beds
276
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2009 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 2006 in GA
Enrollment address
1514 Vernon Rd
Lagrange, GA 30240-4131
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Short-term

Other NPIs with the same Medicare PAC ID 2

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
Wellstar West Georgia Medical CenterCCN 110016 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
West Ga Medical Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

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 Apr 1, 2016 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 Apr 1, 2016 5%
John C McKibben Individual Corporate DirectorBoard Member Oct 1, 2009 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 1, 2016 5%
Wellstar Health System Inc Organization, Marietta, GA Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 1, 2016 100%
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 EmployeeExecutive Director of Reimbursement Apr 1, 2016 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 Apr 1, 2016 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 Apr 1, 2016 5%

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 2

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

FacilityTypeRoleSince
West Georgia Home CareLagrange, GA, CCN 117032 Home health agency 5% Or Greater Direct Ownership Interest Oct 1, 2009
West Georgia HospiceLagrange, GA, CCN 111516 Hospice 5% Or Greater Direct Ownership Interest Oct 1, 2009

Owned or controlled facilities with NPI records 2

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

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 34

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 34

Affiliated clinicians 292

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

View all 292

NPI Registry JSON

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

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1821221144",
    "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",
            "fax_number": "770-999-2489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-882-1411",
            "fax_number": "706-845-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-03",
        "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": "EVP",
        "authorized_official_telephone_number": "470-644-0012",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00002065A",
            "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 West Georgia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Georgia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Georgia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

Verify at the official NPI Registry.