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JACOB R PETERSON AA
NPI 1235249442
Anesthesiologist Assistant in La Crosse, WI

Active since August 30, 2006Accepts Medicare Assignment
1836 SOUTH AVE, LA CROSSE, WI 54601(608) 782-7300 Get Directions Write a Review

NPPES record last updated: March 22, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jacob R Peterson Aa NPPES

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

JACOB R PETERSON AA (NPI 1235249442) is an individual anesthesiologist assistant in La Crosse, Wisconsin and active in the NPI registry since August 2006. He is affiliated with Gundersen Lutheran Medical Center and is a graduate of Other (2006).

NPPES Registry Identity

NPI1235249442
Entity TypeIndividualMale
Primary Taxonomy367H00000X
Provider Legal NameJACOB R PETERSONCredential: AA
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 2006
Enumeration DateAugust 30, 2006
Last NPPES UpdateMarch 22, 2016
✔ NPI 1235249442 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologist AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367H00000X
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.
1836 SOUTH AVE, La Crosse, WI 54601
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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

Jacob R Peterson Aa 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 ID5496752669
PECOS Enrollment IDI20061031000529

Medicare Billing Reassignments

2

Medicare enrollment records show Jacob Peterson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Gundersen Clinic Ltd
Same address
Clinic/Center
1836 SOUTH AVE
La Crosse, WI 54601
  • Reassigned Medicare billing, Wisconsin enrollment
  • 928 clinicians in this Medicare group
NPI 1851343115 (608) 782-7300
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.

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 Jacob Peterson's NPI number?

The NPI number for Jacob Peterson is 1235249442. It was assigned to this individual provider in the NPPES registry on August 30, 2006.

Where is Jacob Peterson located?

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

What is Jacob Peterson's specialty?

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

Is Jacob Peterson enrolled in Medicare?

Yes. Jacob Peterson 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 organizations bill Medicare for Jacob Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Peterson reassigns Medicare benefits to 2 organizations: Gundersen Clinic Ltd (La Crosse, WI) and Gundersen Lutheran Medical Center, Inc (La Crosse, WI). Each 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 Jacob Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Jacob Peterson affiliated with any hospitals?

According to CMS data, Jacob Peterson is affiliated with Gundersen Lutheran Medical Center.

When was this NPI record last updated?

The NPPES record for Jacob Peterson was last updated on March 22, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.