ALYSE FANDRICH
NPI 1508418203
Counselor - Professional in Baxley, GA

Q: What is Alyse Fandrich's NPI number?

The NPI number for Alyse Fandrich is 1508418203. It was assigned to this individual provider in the NPPES registry on July 12, 2019.

Q: What is Alyse Fandrich's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Alyse Fandrich was last updated on July 12, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.

Active since July 12, 2019PECOS Enrolled

755 S MAIN ST, BAXLEY, GA 31513(912) 367-4614(912) 367-9048 Get Directions Write a Review

NPPES record last updated: July 12, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Alyse Fandrich NPPES

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

ALYSE FANDRICH (NPI 1508418203) is an individual professional provider in Baxley, Georgia, licensed in Georgia (LPC010854) and active in the NPI registry since July 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1508418203

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameALYSE FANDRICH

Location Address755 S MAIN STBaxley, GA 31513-0130

Mailing Address755 S Main StBaxley, GA 31513-0130 · (912) 367-4614 · Fax (912) 367-9048

Phone(912) 367-4614

Fax(912) 367-9048

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateJuly 12, 2019

✔ NPI 1508418203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in GA · LPC010854

755 S MAIN ST, Baxley, GA 31513

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Alyse Fandrich is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7517430341

PECOS Enrollment IDI20260624000843

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 Reassignment

Medicare enrollment records show Alyse Fandrich reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pineland Area Community Services Board

58 mi

Community/Behavioral Health

11 N COLLEGE ST
Statesboro, GA 30458

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

NPI 1588735252 (912) 764-9868

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

Other Providers at the Same Location NPPES 3

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

APPLING COUNSELING CENTER

Community/Behavioral Health

755 S MAIN ST
BAXLEY, GA 31513

Appling County (912) 367-4614

MRS. BRENDA M. THOMPSON FNP

Nurse Practitioner

755 S MAIN ST
BAXLEY, GA 31513

Appling County (912) 705-2273

SOUTHERN PHARMACARE LLC

Pharmacy (Community/Retail Pharmacy)

755 S MAIN ST
BAXLEY, GA 31513

Appling County (912) 294-1684

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 Alyse Fandrich's NPI number?

The NPI number for Alyse Fandrich is 1508418203. It was assigned to this individual provider in the NPPES registry on July 12, 2019.

Where is Alyse Fandrich located?

Alyse Fandrich practices at 755 S Main St, Baxley, GA 31513. The listed phone number is (912) 367-4614.

What is Alyse Fandrich's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Alyse Fandrich enrolled in Medicare?

Yes. Alyse Fandrich is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Alyse Fandrich's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Alyse Fandrich reassigns Medicare benefits to Pineland Area Community Services Board (Statesboro, GA). The 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 Alyse Fandrich'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 Alyse Fandrich was last updated on July 12, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.