1. Home
  2. Directory
  3. Wisconsin
  4. La Crosse
  5. Anesthesiologist Assistant
  6. NPI Profile

NICHOLAS SAMPLE CAA
NPI 1205236031
Anesthesiologist Assistant in La Crosse, WI

Active since August 29, 2014Accepts Medicare Assignment
1836 SOUTH AVE, LA CROSSE, WI 54601(608) 782-7300 Get Directions Write a Review

NPPES record last updated: October 29, 2021. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Nicholas Sample Caa NPPES

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

NICHOLAS SAMPLE CAA (NPI 1205236031) is an individual anesthesiologist assistant in La Crosse, Wisconsin, licensed in Wisconsin (195-17) and active in the NPI registry since August 2014. He is affiliated with Gundersen Lutheran Medical Center, maintains a secondary practice location in Wildwood, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1205236031
Entity TypeIndividualMale
Primary Taxonomy367H00000X
Provider Legal NameNICHOLAS SAMPLECredential: CAA
Location Address1836 SOUTH AVELa Crosse, WI 54601-5429
Mailing Address1836 South AveLa Crosse, WI 54601-5429 · (608) 782-7300
Phone(608) 782-7300
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateAugust 29, 2014
Last NPPES UpdateOctober 29, 2021
NPPES CertifiedOctober 29, 2021
✔ NPI 1205236031 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAnesthesiologist AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367H00000X
License✔ Licensed in WI · 195-17
Definition
An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist.
Also ListedSpecialist/Technologist · Athletic TrainerTaxonomy 2255A2300X
1836 SOUTH AVE, La Crosse, WI 54601
Open in Google Maps ↗

Secondary Practice Location 1

Location 1537 Crown Pointe Estates CtWildwood, MO 63021-2012 · Phone (314) 971-5488

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicholas Sample Caa 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 ID4284023607
PECOS Enrollment IDI20211105000090

Medicare Billing Reassignment

Medicare enrollment records show Nicholas Sample reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Gundersen Lutheran Medical Center, Inc
Same address
Clinic/Center
710 DENTON ST
La Crosse, WI 54601
  • Reassigned Medicare billing, Wisconsin enrollment
  • 1,457 clinicians in this Medicare group
NPI 1619210895 (608) 782-7300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Anesthesia for lens surgery 00142
Anesthesia for lens surgery involves administering medication to numb the eye area, ensuring you feel no pain during the procedure. This can be a local anesthetic (numbing only the eye area) or general (where you're asleep). It helps make the surgery comfortable and stress-free.
23 services23 patients

Hospital Affiliations CMS Care Compare

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

Gundersen Lutheran Medical Center

Acute Care Hospitals · La Crosse, WI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520087
Location1910 South AveLa Crosse, WI 54601 · La Crosse County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

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

JEFFREY BRIAN TROHKIMOINEN M.D.
Anesthesiology
1836 SOUTH AVE, GUNDERSEN CLINIC, LTD.
LA CROSSE, WI 54601
La Crosse County (608) 775-2031
JESSICA E THESING CRNA
Nurse Anesthetist, Certified Registered
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
DR. MICHAEL DAVID SMITH PSY.D.
Psychologist
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
JESSICA MAE RASMUSSEN
Surgery
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
JULIE SONSALLA NP
Nurse Practitioner (Adult Health)
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
LAURA KLINGBEIL
Orthopaedic Surgery
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
SUSAN CAROL SORRENTINO RN
Registered Nurse (Addiction (Substance Use Disorder))
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300
NAOMI MUTHONI RUIRU NP
Nurse Practitioner (Family)
1836 SOUTH AVE
LA CROSSE, WI 54601
La Crosse County (608) 782-7300

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 Nicholas Sample's NPI number?

The NPI number for Nicholas Sample is 1205236031. It was assigned to this individual provider in the NPPES registry on August 29, 2014.

Where is Nicholas Sample located?

Nicholas Sample practices at 1836 South Ave, La Crosse, WI 54601. The listed phone number is (608) 782-7300.

What is Nicholas Sample's specialty?

The primary specialty registered for this NPI is Anesthesiologist Assistant with taxonomy code 367H00000X.

Is Nicholas Sample enrolled in Medicare?

Yes. Nicholas Sample is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Nicholas Sample's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Sample reassigns Medicare benefits to Gundersen Lutheran Medical Center, Inc (La Crosse, WI). 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 Nicholas Sample's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Nicholas Sample affiliated with any hospitals?

According to CMS data, Nicholas Sample is affiliated with Gundersen Lutheran Medical Center.

When was this NPI record last updated?

The NPPES record for Nicholas Sample was last updated on October 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.