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MR. JASON FORDYCE PMHNP-BC
NPI 1346816865
Nurse Practitioner - Psychiatric/Mental Health in Villa Rica, GA

Active since June 03, 2021PECOS Enrolled
307 OLD STONE RD, VILLA RICA, GA 30180(770) 459-8799 Get Directions Write a Review

NPPES record last updated: July 8, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 8, 2021, Jun 3, 2021 (2 updates tracked since 2021).

About Mr. Jason Fordyce Pmhnp-bc NPPES

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

MR. JASON FORDYCE PMHNP-BC (NPI 1346816865) is an individual psychiatric/mental health provider in Villa Rica, Georgia, licensed in Georgia (RN223272) and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1346816865
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameMR. JASON FORDYCECredential: PMHNP-BC
Location Address307 OLD STONE RDVilla Rica, GA 30180-1214
Mailing Address307 Old Stone RdVilla Rica, GA 30180-1214 · (770) 459-8799
Phone(770) 459-8799
Sole ProprietorNo
Enumeration DateJune 3, 2021
Last NPPES UpdateJuly 8, 20212 updates tracked since enumeration
NPPES CertifiedJuly 8, 2021
✔ NPI 1346816865 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in GA · RN223272
307 OLD STONE RD, Villa Rica, GA 30180
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jason Fordyce Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Jason Fordyce reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mobolaji Shalom Oyebanjo, Inc
Same address
Psychiatry
307 OLD STONE RD
Villa Rica, GA 30180
  • Reassigned Medicare billing, Georgia enrollment
  • 10 clinicians in this Medicare group
NPI 1922280684 (770) 459-8799
Gwinnett Physician Group, LLC
54 mi
Internal Medicine
1000 MEDICAL CENTER BLVD, MOB 100 SUITE 210
Lawrenceville, GA 30046
  • Reassigned Medicare billing, Georgia enrollment
  • 275 clinicians in this Medicare group
NPI 1578574661 (855) 709-4535

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30180 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.23 typical visit price
range $53.31 – $164.04
Typical copayment $20.80 (range $13.32 – $41.01)
Most-billed visit code 99203
Established Patient
$94.84 typical visit price
range $16.68 – $133.24
Typical copayment $23.71 (range $4.17 – $33.31)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

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

POTTERS HANDS INSTITUTE LLC
Clinic/Center (Rehabilitation, Substance Use Disorder)
307 OLD STONE RD
VILLA RICA, GA 30180
Carroll County (770) 459-8799
OMOBOLAJI OLUSEYI OYEBANJO POPOOLA MD
Psychiatry & Neurology (Addiction Psychiatry)
307 OLD STONE RD
VILLA RICA, GA 30180
Carroll County (770) 459-8799
LARRY DEWITT FULLER JR. M.A.
Counselor (Professional)
307 OLD STONE RD
VILLA RICA, GA 30180
Carroll County (770) 459-8799
MARDEEA JARTU LPC
Counselor (Professional)
307 OLD STONE RD
VILLA RICA, GA 30180
Carroll County (770) 459-8799
MOBOLAJI SHALOM OYEBANJO, INC
Psychiatry & Neurology (Psychiatry)
307 OLD STONE RD
VILLA RICA, GA 30180
Carroll County (770) 459-8799

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 Jason Fordyce's NPI number?

The NPI number for Jason Fordyce is 1346816865. It was assigned to this individual provider in the NPPES registry on June 3, 2021.

Where is Jason Fordyce located?

Jason Fordyce practices at 307 Old Stone Rd, Villa Rica, GA 30180. The listed phone number is (770) 459-8799.

What is Jason Fordyce's specialty?

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

Is Jason Fordyce enrolled in Medicare?

Yes. Jason Fordyce is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Jason Fordyce's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jason Fordyce reassigns Medicare benefits to 2 organizations: Mobolaji Shalom Oyebanjo, Inc (Villa Rica, GA) and Gwinnett Physician Group, LLC (Lawrenceville, GA). Each 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 Jason Fordyce's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jason Fordyce was last updated on July 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.