Yes
DSH110091A | Child | DSH | Piedmont Rockdale Hospital, Inc. | Piedmont Rockdale Hospital - Outpatient Physical Therapy | 1290 Wellbrook Circle | Conyers | GA | Active |
DSH110091B | Child | DSH | Piedmont Rockdale Hospital, Inc. | Piedmont Rockdale Hospital - Outpatient Speech Therapy | 1290 Wellbrook Circle | Conyers | GA | Active |
DSH110091C | Child | DSH | Piedmont Rockdale Hospital, Inc. | Piedmont Oncology Institute - Oncology | 1412 Milstead Ave NE | Conyers | GA | Active |
Details | Last Recertification Date | Update | Recertification | 8/31/2023 8:53:01 AM | 8/29/2024 11:04:45 AM | 8/29/2024 11:04 AM |
Contacts | Signed By | Update | Profile Change Request | Wynn, Marty
CFO
Piedmont Rockdale Hospital
7709183101 | Wynn, Marty
CFO
Piedmont Eastside Medical Center
7707362420 | 1/17/2024 9:13 AM |
Contacts | Authorizing Official | Update | Change Request | Roberts, Justin
CFO
Piedmont Rockdale Hospital
7709183101 | Witherell, Stewart
CFO
Piedmont Healthcare
7709183101 | 12/1/2023 12:56 PM |
Details | Last Recertification Date | Update | Recertification | 9/9/2022 9:49:43 AM | 8/31/2023 8:53:01 AM | 8/31/2023 8:53 AM |
Contacts | Authorizing Official | Update | AO Change Request | Wynn, Marty
CFO
Piedmont Rockdale Hospital
7709183101 | Roberts, Justin
CFO
Piedmont Rockdale Hospital
7709183101 | 8/30/2023 11:37 AM |
Details | Last Recertification Date | Update | Recertification | 8/20/2021 11:01:54 AM | 9/9/2022 9:49:43 AM | 9/9/2022 9:49 AM |
Details | Last Recertification Date | Update | Recertification | 9/10/2020 7:55:38 AM | 8/20/2021 11:01:54 AM | 8/20/2021 11:01 AM |
Medicaid Billing | NPI: State | Update | Recertification | | GA | 9/10/2020 7:55 AM |
Details | Last Recertification Date | Update | Recertification | 8/19/2019 9:35:24 AM | 9/10/2020 7:55:38 AM | 9/10/2020 7:55 AM |
Details | Last Recertification Date | Update | Recertification | | 8/19/2019 9:35:24 AM | 8/19/2019 9:35 AM |
Details | State | Update | | Approved | Active | 4/1/2019 12:05 AM |
Details | Entity Name | Update | Change Request | ROCKDALE MEDICAL CENTER | Piedmont Rockdale Hospital, Inc. | 3/6/2019 8:11 AM |
Details | Entity Name | Update | Reinstatement | ROCKDALE HOSPITAL DBA ROCKDALE MEDICAL CENTER | ROCKDALE MEDICAL CENTER | 1/22/2019 2:41 PM |
Contacts | Signed By | Insert | New Registration | | Wynn, Marty
CFO
Piedmont Rockdale Hospital
7709183101 | 1/16/2019 11:36 AM |
Details | 340B ID | Update | New Registration | | DSH110091A | 1/16/2019 11:36 AM |
Details | Entity Name | Update | New Registration | ROCKDALE MEDICAL CENTER | ROCKDALE HOSPITAL DBA ROCKDALE MEDICAL CENTER | 1/16/2019 11:36 AM |
Details | Entity Subname | Update | New Registration | Piedmont Rockdale Hospital | Piedmont Rockdale Hospital - Outpatient Physical Therapy | 1/16/2019 11:36 AM |
Dates | Participating Approval Date | Update | New Registration | | 1/16/2019 11:36:22 AM | 1/16/2019 11:36 AM |
Details | State | Update | New Registration | Pending | Approved | 1/16/2019 11:36 AM |
Dates | Signed By Date | Update | New Registration | | 1/15/2019 4:14:57 PM | 1/16/2019 11:36 AM |
Dates | Start Date | Update | New Registration | | 4/1/2019 12:00:00 AM | 1/16/2019 11:36 AM |
Addresses | Main Address | Insert | New Registration | |
1290 Wellbrook Circle
Conyers, GA 30012 | 1/14/2019 5:19 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 1/14/2019 5:19 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 000001603A | 1/14/2019 5:19 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | GA | 1/14/2019 5:19 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1306355680 | 1/14/2019 5:19 PM |
Contacts | Primary Contact | Insert | New Registration | | Miller, Amanda Meriwether
Director of Pharmacy
Piedmont Rockdale Hospital, Inc.
7709183752 | 1/14/2019 5:19 PM |
Contacts | Authorizing Official | Insert | New Registration | | Wynn, Marty
CFO
Piedmont Rockdale Hospital
7709183101 | 1/14/2019 5:19 PM |
Details | Last Recertification Date | Insert | New Registration | | | 1/14/2019 5:19 PM |
Details | Grant Number | Insert | New Registration | | | 1/14/2019 5:19 PM |
Details | 340B ID | Insert | New Registration | | | 1/14/2019 5:19 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/14/2019 5:19 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/14/2019 5:19 PM |
Details | Medicare Provider Number | Insert | New Registration | | 110091 | 1/14/2019 5:19 PM |
Details | Entity Name | Insert | New Registration | | ROCKDALE MEDICAL CENTER | 1/14/2019 5:19 PM |
Details | Program Code | Insert | New Registration | | DSH | 1/14/2019 5:19 PM |
Details | Entity Subname | Insert | New Registration | | Piedmont Rockdale Hospital | 1/14/2019 5:19 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 1/14/2019 5:19 PM |
Details | State | Insert | New Registration | | Pending | 1/14/2019 5:19 PM |
Dates | Registration Date | Insert | New Registration | | 1/14/2019 5:19:59 PM | 1/14/2019 5:19 PM |
Dates | Signed By Date | Insert | New Registration | | | 1/14/2019 5:19 PM |
Dates | Start Date | Insert | New Registration | | | 1/14/2019 5:19 PM |
Terminations | Termination Comments | Insert | New Registration | | | 1/14/2019 5:19 PM |
Terminations | Termination Date | Insert | New Registration | | | 1/14/2019 5:19 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 1/14/2019 5:19 PM |
Terminations | Termination Reason | Insert | New Registration | | | 1/14/2019 5:19 PM |