Andrea Prokop, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD61055460 Issued in WA

Practice address

1200 NW 23Rd Avenue
Legacy Clinic Good Samaritan
Portland, OR 97210

Phone

(503) 413-7074

Fax

(503) 413-6393

NPI assigned

May 24, 2017

Reactivated

Jan 31, 2018

Sex

Female

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 WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Sound Inpatient Physicians PLLCGroup PAC ID 5991618738, 424 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St Joseph Medical Center Hospital, Bellingham, WA, CCN 500030

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aprokop437709@direct.peacehealth.org

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.

• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1023285756
  Medicare reassignment Care Compare group NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Hillsboro, OR
  • NPI 1508023789
  NPD
• Cogent Healthcare of Washington, PC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1861430522
  NPD
• Peacehealth

  • Rural Acute Care Hospital
  • Bellingham, WA
  • NPI 1487904546
  NPD (past)

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

• Peacehealth

  • Rural Acute Care Hospital
  • Bellingham, WA
  • NPI 1487904546
  Care Compare affiliation
• Peacehealth

  • General Acute Care Hospital
  • Bellingham, WA
  • NPI 1689677320
  Care Compare affiliation
• St Joseph Hospital

  • Clinical Medical Laboratory
  • Bellingham, WA
  • NPI 1013137173

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1760910558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW 23RD AVENUE",
            "address_2": "LEGACY CLINIC GOOD SAMARITAN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97210",
            "telephone_number": "503-413-7074",
            "fax_number": "503-413-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NW 23RD AVENUE",
            "address_2": "LEGACY CLINIC GOOD SAMARITAN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97210",
            "telephone_number": "503-413-7074",
            "fax_number": "503-413-6393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROKOP",
        "first_name": "ANDREA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "deactivation_date": "2017-12-28",
        "reactivation_date": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61055460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Project Quest
• Project Quest
• Project Quest
• Project Quest
• Project Quest
• Ingmar Klaseen Prokop, M.D.
• Joao Prola Netto, M.D.
• Prolific Wellness
• Promuveo LLC
• Jordin Whitney Pronath-Holden

• Internal Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; 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.