NPIMap

Individual provider Active NPI

Lynnette K Prokop, PA

  • Surgical Physician Assistant
  • Memphis, TN
National Provider Identifier
1205292497
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4968 Issued in TN
Practice address
1325 Eastmoreland Ave Ste 310
Memphis, TN 38104-7544
Phone
(901) 758-7970
Fax
(901) 266-6425
NPI assigned
Jan 5, 2016
Last updated
Apr 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.004572RX OH
Surgical Physician Assistant 363AS0400X 4968 TN Primary

Addresses

Primary practice location

1325 Eastmoreland Ave Ste 310
Memphis, TN 38104-7544

Mailing address

1211 Union Ave Ste 330
Memphis, TN 38104-6655
Phone (901) 758-7970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160318001860 OH Practitioner - Physician Assistant 9537466503 Reassigns benefits to 3 organizations
I20220413001292 TN Practitioner - Physician Assistant 9537466503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Hospitals Medical Group IncGroup PAC ID 4789682493, 2,248 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

36000 Euclid Ave
Willoughby, OH 44094-4625
Phone (216) 844-3800

3999 Richmond Rd
Beachwood, OH 44122-6046
Phone (216) 593-5500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.19 of 100Reported as group
Quality
63.13
Promoting interoperability
100
Improvement activities
40
Cost
74.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4968TNMDSpeech-Language Pathologist
50.004572RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc CurrentSince Feb 25, 2017 Accepting new patients
New Manna CLG, LLC Physician Assistant CurrentSince Jan 7, 2020 Accepting new patients
Lake Hospital System, Inc Past Accepting new patients
Paul F Vanek Jr M D Inc Past Accepting new patients

Locations

25501 Chagrin Blvd
Beachwood, OH 44122
Phone (216) 545-4800

25701 N Lakeland Blvd
Ste 305
Euclid, OH 44132
Phone (216) 731-5212

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

Interoperability endpoints

  • Direct secure messaging: lprokop96692@ehrdirect.uhhospitals.org

Organizations & group practices 7

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

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1205292497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 330",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046655",
            "telephone_number": "901-758-7970",
            "fax_number": "901-266-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE STE 310",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047544",
            "telephone_number": "901-758-7970",
            "fax_number": "901-266-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROKOP",
        "first_name": "LYNNETTE",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004572RX",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "4968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.