Jacquelyn Nicole Prokop, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007908 Issued in MI

Practice address

301 W Wackerly St
Midland, MI 48640-2761

Phone

(989) 832-0900

Fax

(989) 633-0349

NPI assigned

Sep 12, 2016

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 names 1

• Jacquelyn Nicole Meehan Former name

Medicare fee-for-service enrollment

Enrolled in MI

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jprokop6737@mymichiganhealth.midirect.net

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.

• Mymichigan Medical Center Midland

  • Multi-Specialty Clinic/Center
  • Midland, MI
  • NPI 1205889490
  Medicare reassignment Care Compare group NPD
• Mymichigan Medical Center Midland

  • Anesthesiology Physician
  • Midland, MI
  • NPI 1649010455
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mymichigan Medical Center Midland

  • Multi-Specialty Clinic/Center
  • Midland, MI
  • NPI 1205889490

  Hospital

  Care Compare affiliation
• Mymichigan Medical Center Midland

  dba Family Practice Center

  • General Acute Care Hospital
  • Midland, MI
  • NPI 1376973149
  Care Compare affiliation
• Mymichigan Medical Center Midland

  • General Acute Care Hospital
  • Midland, MI
  • NPI 1902841414
  Care Compare affiliation

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1144778812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486402761",
            "telephone_number": "989-832-0900",
            "fax_number": "989-633-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486402761",
            "telephone_number": "989-832-0900",
            "fax_number": "989-633-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROKOP",
        "first_name": "JACQUELYN",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-12",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "MEEHAN",
            "middle_name": "NICOLE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carol J Prinzo, NP
• Cheryl Prior
• Pro-Health Medical Midland Inc
• Lori Deann Profit, PHARMD
• Scott Randolph Profit, RPH
• Tarah Propp
• Kim Pross, NURSE
• Victoria Pruitt, PT, DPT
• Kevin Gerard Przybylski, PHARM.D.
• Heather L Pugsley, BS

• Physician Assistant in Midland, MI
• Providers in Midland, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.