Jean Robert Ferdinand, MD
Individual provider Active NPI Family Medicine Physician · Locust Grove, GA
NPI 1265744759 · NPPES record last updated May 16, 2019
Key facts
- NPI
- 1265744759
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 64216 (GA)
- Practice address
- 3334 Highway 155
Locust Grove, GA 30248-3513 - Phone
- (770) 305-7929
- Fax
- (770) 305-7969
- NPI assigned
- Jul 13, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Albany Medical College of Union University, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Qcpi-Villagemd PC
Practice addresses (Care Compare)
1805 Parke Plaza Cir
Suite 101
Stone Mountain, GA 30087-3646
Phone (770) 879-0436
210 College St
McDonough, GA 30253-3300
Phone (470) 878-6401
Hospital & facility affiliations
- Central Home Health Care, an Amedisys Company
- Piedmont Henry Hospital
- Northside Hospital
- Wellstar Spalding Medical Center
- Piedmont Fayette Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150115000375 | GA | Practitioner - Family Practice |
7618146424 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64216 | GA | MD | Family Medicine Physician |
| 7553 | KS | MD | Sports Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jameson a Estes, MD, PC | Family Medicine | Current | Accepting new patients |
| Shannon T. Barton MD LLC | Family Medicine | Current | Accepting new patients |
| Venture Medical Associates LLC | Family Medicine | Current |
Accepting new patients |
| Jacksonville Surgical & Medical Affiliates, LLC | Past | Accepting new patients | |
| Jacksonville Medical Professional Services LLC | Past | Accepting new patients |
Locations
3334 Highway 155
#A
Locust Grove, GA 30248
Phone (678) 429-8146
210 College St
McDonough, GA 30253
Phone (470) 878-6401
545 Venture Ct
Monticello, GA 31064
Phone (706) 468-7002
Interoperability endpoints
- jean.ferdinand.1@18021.direct.athenahealth.com
- jean.ferdinand.1@21533.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 7553 | KS | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 31037 | AL | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 64216 | GA | |
| Family Medicine Physician | 207Q00000X | 64216 | GA | Yes |
Addresses
Primary practice location
3334 Highway 155
Locust Grove, GA 30248-3513
Mailing address
4303 Jodeco Rd
McDonough, GA 30253-8297
Phone (770) 898-7840
Other practice location 1
210 College St
McDonough, GA 30253-3300
Phone (470) 878-6401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003111758C | Medicaid | GA | |
| 12263436 | Other | CAQH |
Other providers in Locust Grove, GA
- Jameson Andrew Estes
- Erica Evans
- David Farmer
- Linda Faulkner
- Theresa Feanny
- Nateka Fielder
- Four Corners Testing LLC
- Regan Joy Frake
- Tieara Freeman
- Fresenius Medical Care Locust Grove, LLC
All providers in Locust Grove, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.