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NORTHSIDE GWINNETT EXTENDED CARE CENTER
NPI 1396788428
Skilled Nursing Facility in Lawrenceville, GA

Active since June 14, 2006CLIA Certified · 9 labs
650 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046(678) 312-3000(678) 312-3065 Get Directions Write a Review

NPPES record last updated: September 18, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Northside Gwinnett Extended Care Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHSIDE GWINNETT EXTENDED CARE CENTER (NPI 1396788428) is a healthcare organization registered as a skilled nursing facility in Lawrenceville, Georgia and active in the NPI registry since June 2006. The organization holds 9 active CLIA laboratory certificates and lists Jorge Hernandez, Vp Admin; Cco, as its authorized official.

NPPES Registry Identity

NPI1396788428
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameNORTHSIDE HOSPITAL, INC.
Location Address650 PROFESSIONAL DRLawrenceville, GA 30046-8707
Mailing Address1000 Johnson Ferry Road, Ne, Attn: Jorge HernandezAtlanta, GA 30342 · (404) 851-6378 · Fax (678) 312-3065
Phone(678) 312-3000
Fax(678) 312-3065
Organization SubpartNo
Authorized OfficialJorge HernandezVp Admin; Cco · (404) 851-6378
Enumeration DateJune 14, 2006
Last NPPES UpdateSeptember 18, 2019
✔ NPI 1396788428 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in GA · 067-460
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
650 PROFESSIONAL DR, Lawrenceville, GA 30046
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Other Names 1

Doing Business AsNorthside Gwinnett Extended Care Center

Other Identifiers 1

Medicaid781382AGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 9

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2273786

Northside Hospital Gwinnett Inpatient Annex · Lawrenceville, GA
Active · expires Dec 19, 2026
CLIA Number11D2273786
Laboratory TypeHospital
Certificate Effective DateDecember 20, 2024
Certificate Expiration DateDecember 19, 2026
Laboratory DirectorYekaternia Eichel
Laboratory Phone(678) 312-4520
Laboratory LocationNorthside Hospital Gwinnett Inpatient Annex650 Professional Drive, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D2287060

Northside Hospital Radiation Oncology - Duluth Hwy · Lawrenceville, GA
Active · expires Aug 7, 2027
CLIA Number11D2287060
Laboratory TypeO/P Dept Of Hospital
Certificate Effective DateAugust 8, 2025
Certificate Expiration DateAugust 7, 2027
Laboratory DirectorDavid Yoo
Laboratory Phone(770) 962-8888
Laboratory LocationNorthside Hospital Radiation Oncology - Duluth Hwy698 Duluth Hwy, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D2286871

Northside Hospital Radiation Oncology-Philip Blvd · Lawrenceville, GA
Active · expires Aug 3, 2027
CLIA Number11D2286871
Laboratory TypeOutpatient Dept Of Hosp
Certificate Effective DateAugust 4, 2025
Certificate Expiration DateAugust 3, 2027
Laboratory DirectorPhilip Shrake
Laboratory Phone(770) 995-3000
Laboratory LocationNorthside Hospital Radiation Oncology-Philip Blvd311 Philip Boulevard, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 11D0860621

Northside Hospital Cancer Institute Shoa Lawrenceville · Lawrenceville, GA
Active · expires Jul 21, 2027
CLIA Number11D0860621
Laboratory TypePhysician Office
Certificate Effective DateJuly 22, 2025
Certificate Expiration DateJuly 21, 2027
Laboratory DirectorDr. Amy Starr
Laboratory Phone(770) 963-8030
Laboratory LocationNorthside Hospital Cancer Institute Shoa Lawrenceville631 Professional Drive, Suite 450, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 11D2229170

Northside Hospital Gwinnett Infusion Center · Lawrenceville, GA
Active · expires Jul 7, 2027
CLIA Number11D2229170
Laboratory TypeOutpatient Dept Of Hosp
Certificate Effective DateJuly 8, 2025
Certificate Expiration DateJuly 7, 2027
Laboratory DirectorPaayal Mehta
Laboratory Phone(678) 312-4220
Laboratory LocationNorthside Hospital Gwinnett Infusion Center575 Professional Drive Suite 510, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D2281733

Northside Hospital Gwinnett 2200 Outpatient Radiology · Lawrenceville, GA
Active · expires May 10, 2027
CLIA Number11D2281733
Laboratory TypeHosp Outpatient Imaging
Certificate Effective DateMay 11, 2025
Certificate Expiration DateMay 10, 2027
Laboratory DirectorDouglas Silver
Laboratory Phone(678) 312-5285
Laboratory LocationNorthside Hospital Gwinnett 2200 Outpatient Radiology2200 Medical Center Boulevard, Lawrenceville, GA 30046
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORTHSIDE HOSPITAL, INC.
Pharmacy (Long Term Care Pharmacy)
650 PROFESSIONAL DR
LAWRENCEVILLE, GA 30046
Gwinnett County (678) 442-3642
PAULINE CARMELA BONDOC-ROAQUIN P.T.
Physical Therapist
650 PROFESSIONAL DR
LAWRENCEVILLE, GA 30046
Gwinnett County (678) 312-3000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northside Hospital, Inc.'s NPI number?

The NPI number for Northside Hospital, Inc. is 1396788428. It was assigned to this organization in the NPPES registry on June 14, 2006. The provider is doing business as Northside Gwinnett Extended Care Center.

Where is Northside Hospital, Inc. located?

Northside Hospital, Inc. is located at 650 Professional Dr, Lawrenceville, GA 30046. The listed phone number is (678) 312-3000.

What is Northside Hospital, Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Northside Hospital, Inc. hold CLIA laboratory certificates?

Yes. 9 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Northside Hospital, Inc. accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Northside Hospital, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northside Hospital, Inc. was last updated on September 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.