NPIMap

Organization Active NPI

Northside Hospital, Inc.

Doing business as Northside Hospital Gwinnett

  • General Acute Care Hospital
  • Lawrenceville, GA
National Provider Identifier
1952340994
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
067-460 Issued in GA
Legal business name
NORTHSIDE HOSPITAL, INC.
Doing business as
Northside Hospital Gwinnett
Practice address
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone
(678) 312-1000
NPI assigned
Jun 5, 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 067-460 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawrenceville, GA 30046-7694

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
000000294AMedicaidGA

Other names 1

  • Northside Hospital Gwinnett 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 GA3 enrollments

Enrollment records 3

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
Practice locations: Lawrenceville, GA; Duluth, GA
O20190907000329 GA Part A Provider - Hospital 9830007236
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952340994. Details of each certification follow.

Hospital certification: CCN 110087

Legal name
NORTHSIDE HOSPITAL INC
Doing business as
NORTHSIDE HOSPITAL GWINNETT
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 15, 2024
Beds
353
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Enrollment address
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Rehabilitation, Psychiatric unit

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 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Northside Hospital GwinnettCCN 110087 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Glancy Rehabilitation CenterCCN 11T087
Ownership
Government
Certified
Jul 1, 1995

This is a unit of this hospital with its own CMS Certification Number. Care Compare reports it separately, and it has no NPI of its own. How units are connected

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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

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 DirectorDirector Aug 28, 2019
Jorge J Hernandez Individual Corporate OfficerVice President Nov 19, 2007
W-2 Managing EmployeeVice President Nov 19, 2007
Robert T. Quattrocchi Individual Corporate OfficerDirector Oct 28, 2004
Corporate DirectorDirector Oct 28, 2004
Thurbert Baker Individual Corporate DirectorDirector May 6, 2019
Wayne Sikes Individual Corporate DirectorDirector Aug 28, 2019
Terri Jondahl Individual Corporate DirectorDirector Aug 28, 2019
Alan K Carnes Individual Corporate DirectorDirector Aug 28, 2019
John Levengood Individual Corporate DirectorDirector Aug 28, 2019
Shannon Banna Individual Corporate OfficerCfo Jan 1, 2019
W-2 Managing EmployeeCfo Jan 1, 2018
Judy Gardner Individual Corporate DirectorVice President Mar 1, 2023
Anthony Salvatore Individual Corporate DirectorDirector May 1, 2005
Iqbal Garcha Individual Corporate DirectorDirector 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 Officer Apr 1, 2026
W-2 Managing Employee Apr 1, 2026
Genevieve L Fairbrother Individual Corporate DirectorDirector Feb 1, 2016
Wayne Lee Ambroze Individual Corporate DirectorDirector Feb 1, 2016
Deborah S Mitcham Individual Corporate DirectorCeo of NHG and NHD Aug 29, 2019
Josef G Venable Individual Corporate DirectorDirector May 1, 2021
Barbara a Pare Individual Corporate DirectorDirector May 1, 2008
Mark J Sweeney Individual Corporate DirectorDirector May 1, 2006
Northside Hospital Inc Organization, Atlanta, GA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 28, 2019 100%
Dale M Bearman Individual Corporate DirectorDirector Feb 1, 2007

Owners & managing parties with NPI records 18

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 18

All facility ownership & control disclosures 2

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

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 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 253

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 253

Affiliated clinicians 1,320

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

View all 1,320

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1952340994",
    "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": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "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": "067-460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000294A",
            "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 Gwinnett",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.