Jack Prothero, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA067306 Issued in PA

Practice address

2566 Haymaker Rd Ste 304
Monroeville, PA 15146-3555

Phone

(412) 858-3070

NPI assigned

Aug 26, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Allegheny ClinicGroup PAC ID 5395649586, 2,313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Forbes Hospital Hospital, Monroeville, PA, CCN 390267

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.

• Allegheny Clinic

  dba AHN-Primary Care Bethel Park

  • Family Medicine Physician
  • Bethel Park, PA
  • NPI 1073081493
  Medicare reassignment Care Compare group
• Allegheny Clinic

  dba AHN Primary Care Mobile Clinic

  • Primary Care Clinic/Center
  • Pittsburgh, PA
  • NPI 1215752548
  NPD
• Allegheny Clinic

  dba AHN Surgery

  • Surgery Physician
  • Pittsburgh, PA
  • NPI 1568462984
  NPD

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

• West Penn Allegheny Health System Inc.

  dba Forbes Regional Hospital

  • General Acute Care Hospital
  • Monroeville, PA
  • NPI 1679592380
  Care Compare affiliation

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

{
    "created_epoch": "1756166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1851279962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2566 HAYMAKER RD STE 304",
            "city": "MONROEVILLE",
            "state": "PA",
            "postal_code": "151463555",
            "telephone_number": "412-858-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2566 HAYMAKER RD STE 304",
            "city": "MONROEVILLE",
            "state": "PA",
            "postal_code": "151463555",
            "telephone_number": "412-858-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROTHERO",
        "first_name": "JACK",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-26",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA067306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "16688712",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Primary Care Pharmacy Services Inc
• Prisk Orthopaedics and Wellness, PC
• Victor Robert Prisk, MD
• Procare Pharmacy Direct, LLC. (CVS Specialty)
• Leslie Ann Prola
• Marita Pugliano, CRNP
• Katherine Anne Pushic, RPH
• Steven Pushic
• Amanda Juliana Quintana
• Susan E Rabe, PA-C

• Surgical Physician Assistant in Monroeville, PA
• Providers in Monroeville, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.