LYNNETTE K PROKOP PA
NPI 1205292497
Physician Assistant - Surgical in Memphis, TN

Q: What is the provider's specialty?

The provider's specialty is Physician Assistant with taxonomy code 363AS0400X and a focus in Surgical.

Active since January 05, 2016PECOS EnrolledAccepts Medicare Assignment

1325 EASTMORELAND AVE STE 310, MEMPHIS, TN 38104(901) 758-7970(901) 266-6425 Get Directions Write a Review

NPPES record last updated: April 5, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 5, 2022, Jan 21, 2016 (2 updates tracked since 2016).

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About Lynnette K Prokop Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LYNNETTE K PROKOP PA (NPI 1205292497) is an individual surgical provider in Memphis, Tennessee, licensed in Tennessee (4968) and active in the NPI registry since January 2016. She is enrolled in Medicare PECOS, is affiliated with Uh Cleveland Medical Center, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1205292497

Entity TypeIndividualFemale

Primary Taxonomy363AS0400X

Provider Legal NameLYNNETTE K PROKOPCredential: PA

Location Address1325 EASTMORELAND AVE STE 310Memphis, TN 38104-7544

Mailing Address1211 Union Ave Ste 330Memphis, TN 38104-6655 · (901) 758-7970 · Fax (901) 266-6425

Phone(901) 758-7970

Fax(901) 266-6425

Sole ProprietorNo

Medical School CMSOtherGraduated 2015

Enumeration DateJanuary 5, 2016

Last NPPES UpdateApril 5, 20222 updates tracked since enumeration

NPPES CertifiedApril 5, 2022

✔ NPI 1205292497 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in TN · 4968

Also ListedPhysician AssistantTaxonomy 363A00000X · License 50.004572RX (OH)

1325 EASTMORELAND AVE STE 310, Memphis, TN 38104

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Lynnette K Prokop Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9537466503

PECOS Enrollment IDI20160318001860

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Uh Cleveland Medical Center

Acute Care Hospitals · Cleveland, OH

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number360137

Location11100 Euclid AvenueCleveland, OH 44106 · Cuyahoga County

Emergency services Birthing friendly

University Hospitals Ahuja Medical Center

Acute Care Hospitals · Beachwood, OH

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number360359

Location3999 Richmond RoadBeachwood, OH 44122 · Cuyahoga County

Emergency services

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REONA MICHELLE ESSON NP

Nurse Practitioner (Acute Care)