JASMINE NICHOLE JACK MD
NPI 1437737392
Psychiatry & Neurology - Psychiatry in Villa Rica, GA

Q: What is Jasmine Jack's NPI number?

The NPI number for Jasmine Jack is 1437737392. It was assigned to this individual provider in the NPPES registry on March 31, 2021.

Q: What is Jasmine Jack's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Jasmine Jack was last updated on July 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.

Active since March 31, 2021PECOS EnrolledAccepts Medicare Assignment

20 HERRELL RD, VILLA RICA, GA 30180(110) 812-3530(770) 812-3531 Get Directions Write a Review

NPPES record last updated: July 17, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 17, 2026, Jul 9, 2026, Mar 31, 2021 (3 updates tracked since 2021).

On this page

About Jasmine Nichole Jack Md NPPES

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

JASMINE NICHOLE JACK MD (NPI 1437737392) is an individual psychiatry provider in Villa Rica, Georgia, licensed in Georgia (113223) and active in the NPI registry since March 2021. She is enrolled in Medicare PECOS and is a graduate of Morehouse School Of Medicine (2021).

NPPES Registry Identity

NPI1437737392

Entity TypeIndividualFemale

Primary Taxonomy2084P0800X

Provider Legal NameJASMINE NICHOLE JACKCredential: MD

Location Address20 HERRELL RDVilla Rica, GA 30180-5527

Mailing Address20 Herrell RdVilla Rica, GA 30180-5527 · (770) 812-3530 · Fax (770) 812-3531

Phone(110) 812-3530

Fax(770) 812-3531

Sole ProprietorNo

Medical School CMSMorehouse School Of MedicineGraduated 2021

Enumeration DateMarch 31, 2021

Last NPPES UpdateJuly 17, 20263 updates tracked since enumeration

NPPES CertifiedJuly 17, 2026

✔ NPI 1437737392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

License✔ Licensed in GA · 113223

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

20 HERRELL RD, Villa Rica, GA 30180

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Harvard Pilgrim Health Care, UnitedHealthcare, WellSense Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jasmine Nichole Jack Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8921537556

PECOS Enrollment IDI20250128002903

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

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

Tmc-Behavioral Health Of West Georgia

1.5 mi

Geriatric Psychiatry

101 QUARTZ DR STE 103B
Villa Rica, GA 30180

Reassigned Medicare billing, Georgia enrollment
73 clinicians in this Medicare group

NPI 1356795462 (770) 812-3530

Mass General Brigham Medical Group Suburban Massachusetts Inc

950 mi

Family Medicine

2014 WASHINGTON STREET
Newton, MA 02462

Reassigned Medicare billing, Massachusetts enrollment
992 clinicians in this Medicare group

NPI 1538191218 (617) 243-6262

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

$164.04 typical visit price

range $53.31 – $164.04

Typical copayment $41.01 (range $13.32 – $41.01)

Most-billed visit code 99205

Established Patient

$66.89 typical visit price

range $16.68 – $133.24

Typical copayment $16.72 (range $4.17 – $33.31)

Most-billed visit code 99213

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 20

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

ALLYSON MOFFATT LPC

Counselor (Mental Health)