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MINDSET HEALTHCARE, PC
NPI 1285119925
Nurse Practitioner - Psychiatric/Mental Health in Fayetteville, GA

Active since September 28, 2018CLIA 11D2178572 · Waiver
135 BRADFORD SQ STE B, FAYETTEVILLE, GA 30215(470) 646-3738(888) 910-6463 Get Directions Write a Review

NPPES record last updated: April 25, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 17, 2021, Nov 11, 2019, Sep 28, 2018 (3 updates tracked since 2018).

About Mindset Healthcare, Pc NPPES

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

MINDSET HEALTHCARE, PC (NPI 1285119925) is a healthcare organization registered as a psychiatric/mental health in Fayetteville, Georgia and active in the NPI registry since September 2018. The organization holds a CLIA Waiver certificate valid through February 4, 2028 and lists Omolola A Otubaga, Aprn-bc/nurse Practioner, as its authorized official.

NPPES Registry Identity

NPI1285119925
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameMINDSET HEALTHCARE, PC
Location Address135 BRADFORD SQ STE BFayetteville, GA 30215-1902
Mailing Address5465 Highway 42 Unit 246Ellenwood, GA 30294-4042 · (470) 646-3738 · Fax (888) 910-6463
Phone(470) 646-3738
Fax(888) 910-6463
Organization SubpartNo
Authorized OfficialOmolola A OtubagaAprn-bc/nurse Practioner · (404) 444-1904
Enumeration DateSeptember 28, 2018
Last NPPES UpdateApril 25, 20233 updates tracked since enumeration
NPPES CertifiedApril 25, 2023
✔ NPI 1285119925 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X
Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X
Also ListedClinical Medical LaboratoryTaxonomy 291U00000X
135 BRADFORD SQ STE B, Fayetteville, GA 30215
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Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mindset Healthcare, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Mindset Healthcare, PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Tianna Crooks, NP
Nurse Practitioner
NPI 1093509028
135 BRADFORD SQ STE B
Fayetteville, GA 30215
(470) 646-3738
✔ PECOSSame address
Omolola Otubaga, NP
Nurse Practitioner
NPI 1033595566
101 BECKETT LN STE. 304
Fayetteville, GA 30214
(770) 703-4448
✔ PECOS✔ Accepts Medicare2.7 mi
Samantha Hudson, MSN, APRN, PMHNP-BC
Nurse Practitioner
NPI 1003701889
85 DOLLY NIXON CT
Senoia, GA 30276
(678) 733-6108
✔ PECOS13 mi
Douglas Cooper, M.D.
Psychiatry
NPI 1255495131
107 DREW CIR
Brunswick, GA 31525
(917) 705-1222
✔ PECOS✔ Accepts Medicare229 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

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 11D2178572

Mindset Healthcare · Fayetteville, GA
Active · expires Feb 4, 2028
CLIA Number11D2178572
Laboratory TypePhysician Office
Certificate Effective DateFebruary 5, 2026
Certificate Expiration DateFebruary 4, 2028
Laboratory DirectorOmolola A. Otubaga
Laboratory Phone(470) 646-3138
Laboratory LocationMindset Healthcare135 Bradford Square Suite B, Fayetteville, GA 30215
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Mindset Healthcare, PC's NPI number?

The NPI number for Mindset Healthcare, PC is 1285119925. It was assigned to this organization in the NPPES registry on September 28, 2018.

Where is Mindset Healthcare, PC located?

Mindset Healthcare, PC is located at 135 Bradford Sq Ste B, Fayetteville, GA 30215. The listed phone number is (470) 646-3738.

What is Mindset Healthcare, PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Mindset Healthcare, PC enrolled in Medicare?

Yes. Mindset Healthcare, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mindset Healthcare, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Mindset Healthcare, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (3) and Psychiatry (1). Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mindset Healthcare, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2178572) is associated with this NPI, valid through February 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mindset Healthcare, PC was last updated on April 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.