ALYSSA PROLLOCK RD
NPI 1215614409
Dietitian, Registered - Nutrition, Oncology in Fairbanks, AK
About Alyssa Prollock Rd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ALYSSA PROLLOCK RD (NPI 1215614409) is an individual nutrition, oncology provider in Fairbanks, Alaska, licensed in Alaska (208636) and active in the NPI registry since June 2023.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Alyssa Prollock Rd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Alyssa Prollock reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fairbanks, AK 99701
- Reassigned Medicare billing, Alaska enrollment
- 172 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FAIRBANKS, AK 99701
FAIRBANKS, AK 99701
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Alyssa Prollock's NPI number?
The NPI number for Alyssa Prollock is 1215614409. It was assigned to this individual provider in the NPPES registry on June 29, 2023.
Where is Alyssa Prollock located?
Alyssa Prollock practices at 1640 Cowles St, Fairbanks, AK 99701. The listed phone number is (907) 458-5629.
What is Alyssa Prollock's specialty?
The primary specialty registered for this NPI is Dietitian, Registered, specializing in Nutrition, Oncology, with taxonomy code 133VN1301X.
Is Alyssa Prollock enrolled in Medicare?
Yes. Alyssa Prollock is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Alyssa Prollock's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Alyssa Prollock reassigns Medicare benefits to Tanana Valley Clinic LLC (Fairbanks, AK). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Alyssa Prollock's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Alyssa Prollock was last updated on June 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Alyssa Prollock, RD · NPI 1215614409
Nutrition, Oncology provider in Fairbanks, Alaska. Individual provider, active in the CMS NPPES registry since June 29, 2023.
## Identity
- **NPI:** 1215614409 (Entity type: Individual)
- **Enumerated:** June 29, 2023
- **Primary specialty:** Dietitian, Registered - Nutrition, Oncology · taxonomy 133VN1301X
- **State license:** 208636 (Alaska)
- **Sole proprietor:** No
## Practice location
- **Address:** 1640 COWLES ST, Fairbanks, AK 99701-5908
- **Phone:** (907) 458-5629
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Tanana Valley Clinic LLC (NPI 1922559558, Fairbanks, AK), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 29, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1215614409) · Data from the CMS NPPES public registry.