TONYA FOWLER FORDHAM D.O.
NPI 1861462053
Family Medicine in Baxley, GA

Q: What is Tonya Fordham's NPI number?

The NPI number for Tonya Fordham is 1861462053. It was assigned to this individual provider in the NPPES registry on January 23, 2006.

Q: What is Tonya Fordham's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Tonya Fordham was last updated on December 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 January 23, 2006PECOS EnrolledAccepts Medicare Assignment

100/100

CMS Quality Rating

18 LUCKIE ST, STE F, BAXLEY, GA 31513(912) 366-1362(912) 366-1365 Get Directions Write a Review

NPPES record last updated: December 21, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 21, 2021, Mar 15, 2016 (2 updates tracked since 2016).

On this page

About Tonya Fowler Fordham D.o. NPPES

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

TONYA FOWLER FORDHAM D.O. (NPI 1861462053) is an individual family medicine provider in Baxley, Georgia, licensed in Georgia (049292) and active in the NPI registry since January 2006. She is enrolled in Medicare PECOS, is affiliated with Appling Healthcare, and is a graduate of West Virginia School Of Osteopathic Medicine (1994).

NPPES Registry Identity

NPI1861462053

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameTONYA FOWLER FORDHAMCredential: D.O.

Location Address18 LUCKIE ST, STE FBaxley, GA 31513-0358

Mailing Address18 Luckie St, Ste FBaxley, GA 31513-0358 · (912) 366-1362 · Fax (912) 366-1365

Phone(912) 366-1362

Fax(912) 366-1365

Sole ProprietorYes

Medical School CMSWest Virginia School Of Osteopathic MedicineGraduated 1994

Enumeration DateJanuary 23, 2006

Last NPPES UpdateDecember 21, 20212 updates tracked since enumeration

NPPES CertifiedDecember 21, 2021

✔ NPI 1861462053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in GA · 049292

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

18 LUCKIE ST, Baxley, GA 31513

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Other Identifiers 2

Other100442Bcbs

Medicaid00947273AGA

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 ›

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

Tonya Fowler Fordham D.o. 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 ID9335158369

PECOS Enrollment IDI20060419000257

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 Tonya Fordham reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

The Baxley And Appling County Hospital Authority

0.5 mi

Surgery

163 E TOLLISON ST
Baxley, GA 31513

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

NPI 1376897488 (912) 367-9841

Southland Emergency Medical Services Consolidated, LLC

72 mi

Hospitalist

145 E PEACOCK ST
Cochran, GA 31014

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

NPI 1033464391 (478) 934-6211

South Georgia ER Services, LLC

75 mi

Emergency Medicine

7505 WATERS AVE STE F10
Savannah, GA 31406

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

NPI 1548763899 (888) 545-5551

Southland Consolidated Emergency Services, LLC

165 mi

Emergency Medicine

4 MEDICAL DR
Elberton, GA 30635

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

NPI 1174917124 (706) 283-3151

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

Areas of Expertise CMS Part B claims 17

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

274 services78 patients

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309

A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.

250 services31 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

143 services58 patients

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count 85025

A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.

116 services60 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

114 services55 patients

Urinalysis, manual test 81002

A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.

111 services55 patients

Injection of drug or substance under skin or into muscle 96372

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

70 services22 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

62 services62 patients

Advance care planning, first 30 minutes 99497

Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.

56 services42 patients

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

35 services23 patients

Blood test, thyroid stimulating hormone (tsh) 84443

A TSH blood test measures the level of thyroid stimulating hormone in your body. This hormone is produced by the pituitary gland and regulates how your thyroid works. It's a simple procedure where a small amount of blood is drawn from your arm for analysis.

28 services25 patients

Emergency department visit with low level of medical decision making 99283

An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.

27 services26 patients

Vitamin d-3 level 82306

A Vitamin D-3 level test measures the amount of Vitamin D-3, a crucial nutrient, in your body. This test helps identify if your levels are too low or too high. Low levels may lead to bone weakness, while high levels could harm your kidneys. It's a simple blood test.

23 services23 patients

Cyanocobalamin (vitamin b-12) level 82607

A Cyanocobalamin (Vitamin B-12) level test is a blood test that checks the amount of Vitamin B-12 in your body. This vitamin is vital for nerve function and the creation of red blood cells. Low or high levels could indicate a potential health issue.

23 services23 patients

Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes G0446

This is a yearly, personal consultation focused on behaviors affecting heart health. It lasts 15 minutes and may cover topics like diet, exercise, and stress management. It's about learning healthy habits to protect your heart.

18 services18 patients

Respiratory infectious agent detection by rna for severe acute respiratory syndrome coronavirus 2 (covid 19), influenza a, influenza b, and respiratory syncytial virus, upper respiratory specimen, each reported as detected or not detected 0241U

This test detects the RNA of respiratory viruses, including COVID-19, Influenza A, Influenza B, and Respiratory Syncytial Virus, in an upper respiratory specimen. The test result will report if each virus is detected or not, helping in accurate diagnosis.

17 services14 patients

Emergency department visit with moderate level of medical decision making 99284

An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.

16 services15 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Appling Healthcare

Acute Care Hospitals · Baxley, GA

OwnershipGovernment - Hospital District or Authority

CMS Certification Number110071

Location163 E Tollison StreetBaxley, GA 31513 · Appling County

Emergency services

Memorial Health Meadows Hospital

Acute Care Hospitals · Vidalia, GA

5/5 CMS rating

OwnershipProprietary

CMS Certification Number110128

LocationOne Meadows ParkwayVidalia, GA 30474 · Toombs County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 31513 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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

100/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Quality

86.51

Promoting Interoperability

100

Improvement Activities

Reported Quality Measures

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use

92%50 patients

Advance Care Plan

79%319 patients4/55-star benchmark: 100%

Appropriate Treatment for Upper Respiratory Infection (URI)

86%21 patients4/55-star benchmark: 100%

Breast Cancer Screening

51%254 patients3/55-star benchmark: 93%

Childhood Immunization Status

6%34 patients

Chlamydia Screening for Women

29%170 patients

Closing the Referral Loop: Receipt of Specialist Report

97%95 patients5/55-star benchmark: 87%

Colorectal Cancer Screening

36%564 patients2/55-star benchmark: 88%

Controlling High Blood Pressure

59%417 patients3/55-star benchmark: 91%

Diabetes: Eye Exam

4%203 patients1/55-star benchmark: 100%

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Lower rates are better for this measure.

30%203 patients4/55-star benchmark: 91%

Documentation of Current Medications in the Medical Record

80%5,434 patients3/55-star benchmark: 100%

e-Prescribing

98%4,000 patients4/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

83%302 patients4/55-star benchmark: 100%

HIV Screening

2%1,122 patients1/55-star benchmark: 60%

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

22%2,739 patients2/55-star benchmark: 61%

Provide Patients Electronic Access to Their Health Information

96%1,500 patients4/55-star benchmark: 100%

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

72%277 patients3/55-star benchmark: 91%

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 2% · 296 patients

Patients totalRate: 17% · 313 patients

19%313 patients3/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

2 suppliers13 claims13 services$6.65 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Tonya Fordham's NPI number?

The NPI number for Tonya Fordham is 1861462053. It was assigned to this individual provider in the NPPES registry on January 23, 2006.

Where is Tonya Fordham located?

Tonya Fordham practices at 18 Luckie St Ste F, Baxley, GA 31513. The listed phone number is (912) 366-1362.

What is Tonya Fordham's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Tonya Fordham enrolled in Medicare?

Yes. Tonya Fordham is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Tonya Fordham's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tonya Fordham reassigns Medicare benefits to 4 organizations: The Baxley And Appling County Hospital Authority (Baxley, GA), Southland Emergency Medical Services Consolidated, LLC (Cochran, GA), South Georgia ER Services, LLC (Savannah, GA) and Southland Consolidated Emergency Services, LLC (Elberton, 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 Tonya Fordham's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Tonya Fordham accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Tonya Fordham 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.

Is Tonya Fordham affiliated with any hospitals?

According to CMS data, Tonya Fordham is affiliated with Appling Healthcare and Memorial Health Meadows Hospital.

When was this NPI record last updated?

The NPPES record for Tonya Fordham was last updated on December 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.