Donna Marie Prokop-Fettig, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA06103 Issued in TX

Practice address

1201 Sam Bass Rd
Round Rock, TX 78681-4137

Phone

(512) 388-1861

Fax

(512) 388-0373

NPI assigned

Dec 18, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aco Jason Martin Medical ConsultingGroup PAC ID 6103327358, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aco Jason Martin Medical Consulting

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1881578961
  Medicare reassignment Care Compare group NPD
• Curana Health Medical Group LLC

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1255640678
  Medicare reassignment
• Jason Martin Medical Consulting LLC

  • General Practice Physician
  • Austin, TX
  • NPI 1851736243
  Medicare reassignment
• Austin Adult Primary Care

  • Primary Care Clinic/Center
  • Austin, TX
  • NPI 1629383054
  NPD (past)
• Round Rock Mental Health PA

  • Psychiatry Physician
  • Round Rock, TX
  • NPI 1538338306

  Medical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252886400000",
    "number": "1013153147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268945",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268945",
            "telephone_number": "512-388-1861",
            "fax_number": "512-388-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SAM BASS RD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814137",
            "telephone_number": "512-388-1861",
            "fax_number": "512-388-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROKOP-FETTIG",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-18",
        "last_updated": "2009-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA06103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028235-02",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028235-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiersten Light Prochnow, LPC
• Carrie Ann Proctor, LPC
• Professional Massage Associates PLLC
• Profound Hospice Care, LLC
• Progressive Life, LTD
• Courtney Pruitt
• Alexis Claris Pruneda, LPC-A
• Madison Ashley Pryor, PA-C
• Psychological Solutions, PLLC
• Madison Ptacek

• Medical Physician Assistant in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.