NPIMap

Organization Active NPI

Hospital Authority of Jefferson County and the City of Louisville

Doing business as Jefferson Hospital Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Louisville, GA
National Provider Identifier
1841361862
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE
Doing business as
Jefferson Hospital Swing Bed
Practice address
1067 Peachtree St
Louisville, GA 30434-1558
Phone
(478) 625-7000
Fax
(478) 625-8907
NPI assigned
Nov 13, 2006
Last updated
Sep 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Authorized official

Name
Jessica Guy
Title
Assistant Administrator
Phone
(478) 625-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

1067 Peachtree St
Louisville, GA 30434-1558

Mailing address

1067 Peachtree St
Louisville, GA 30434-1558
Phone (478) 625-7000

Other identifiers 1

IdentifierTypeStateIssuer
000001031SMedicaidGA

Other names 1

  • Jefferson Hospital Swing Bed Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226001055 GA Part B Supplier - Clinic/Group Practice 7214823046 Receives reassigned benefits from 16 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, GA; Wadley, GA; Wrens, GA
O20071207000909 GA Part A Provider - Hospital 7214823046 Practice locations: Louisville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841361862. Details of each certification follow.

Hospital certification: CCN 11U100

Legal name
HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE
Doing business as
JEFFERSON HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Aug 26, 1977 in GA
Enrollment address
1067 Peachtree Street
Louisville, GA 30434-1558
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

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
William Easterlin Individual Corporate DirectorBoard Member Oct 1, 2007
Jessica Guy Individual W-2 Managing Employee Jan 1, 2017
John Johnson Individual Corporate DirectorBoard Member Oct 1, 2007
Lee Woods Individual Corporate DirectorBoard Member Jan 1, 2011
Wendy Martin Individual Corporate Officer Sep 9, 2019
Hospital Authority of Jefferson County and the City of Louisville Organization, Louisville, GA Operational/Managerial Control Aug 26, 1977
Other Aug 26, 1977
Mary Clark Individual Corporate DirectorBoard Member Oct 1, 2007

Owners & managing parties with NPI records 5

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
Jefferson HospitalLouisville, GA, CCN 11S100 Hospital Operational/Managerial Control Aug 26, 1977
Physicians Health Group WadleyWadley, GA, CCN 113453 Rural health clinic Operational/Managerial Control
Other		 Sep 10, 2014
Aug 26, 1977
Physicians Health GroupLouisville, GA, CCN 113420 Rural health clinic 5% Or Greater Direct Ownership Interest
Other		 Aug 26, 1977
Aug 26, 1977

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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1841361862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1067 PEACHTREE ST",
            "city": "LOUISVILLE",
            "state": "GA",
            "postal_code": "304341558",
            "telephone_number": "478-625-7000",
            "fax_number": "478-625-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1067 PEACHTREE ST",
            "city": "LOUISVILLE",
            "state": "GA",
            "postal_code": "304341558",
            "telephone_number": "478-625-7000",
            "fax_number": "478-625-8907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "GUY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "478-625-7000"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001031S",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Hospital Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Hospital Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, GA

Sources for this page

Verify at the official NPI Registry.