Ian Roger Prochaska, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007518 Issued in MI

Practice address

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000

Phone

(734) 936-6666

NPI assigned

Sep 25, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

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.

• Emergency Medicine Physicians of Genesee County, PLLC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1275899171
  Medicare reassignment
• Observation Medicine Group PLLC

  • Emergency Medicine Physician
  • Grand Blanc, MI
  • NPI 1194084111
  Medicare reassignment
• Regents of the University of Michigan

  • Physician Assistant
  • Ann Arbor, MI
  • NPI 1689609448
  Medicare reassignment
• Regents of the University of Michigan

  • Physician Assistant
  • Brighton, MI
  • NPI 1457378036
  NPD
• Regents of the University of Michigan

  • Specialty Pharmacy
  • Dexter, MI
  • NPI 1952181919
  NPD

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1649640293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-936-6666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Genesys Pkwy",
            "address_purpose": "LOCATION",
            "city": "Grand Blanc",
            "state": "MI",
            "postal_code": "484398065",
            "country_code": "US",
            "telephone_number": "810-606-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCHASKA",
        "first_name": "IAN",
        "middle_name": "ROGER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-25",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601007518",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Lynn Pritula, NP
• Laura Marie Pritz, PA-C
• Franklin McNeill Privette, MD
• Stephanie Anne Probert
• Courtney Lynn Prochaska, CPNP-PC
• Maggie Prochaska
• Zachary Wayne Prochaska, PA-C
• Sandra G Prochazka, LMSW
• Iris Marie Proctor, LLMSW
• Stacia Marie Proefrock

• Physician Assistant in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.