NICHOLAS PEDERSEN
NPI 1619502275
Physician Assistant in Cumberland, WI

Q: What is Nicholas Pedersen's NPI number?

The NPI number for Nicholas Pedersen is 1619502275. It was assigned to this individual provider in the NPPES registry on March 4, 2020.

Q: What is Nicholas Pedersen's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Pedersen was last updated on March 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.

Active since March 04, 2020PECOS EnrolledAccepts Medicare Assignment

1705 16TH AVE, CUMBERLAND, WI 54829(715) 822-7500(715) 822-7501 Get Directions Write a Review

NPPES record last updated: March 24, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 24, 2026, Jun 17, 2020, Mar 4, 2020 (3 updates tracked since 2020).

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About Nicholas Pedersen NPPES

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

NICHOLAS PEDERSEN (NPI 1619502275) is an individual physician assistant in Cumberland, Wisconsin, licensed in Wisconsin (5071) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS, is affiliated with Cumberland Memorial Hospital, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1619502275

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameNICHOLAS PEDERSEN

Location Address1705 16TH AVECumberland, WI 54829-8601

Mailing Address1705 16th AveCumberland, WI 54829-8601 · (715) 822-7500 · Fax (715) 822-7501

Phone(715) 822-7500

Fax(715) 822-7501

Sole ProprietorYes

Medical School CMSOtherGraduated 2020

Enumeration DateMarch 4, 2020

Last NPPES UpdateMarch 24, 20263 updates tracked since enumeration

NPPES CertifiedMarch 24, 2026

✔ NPI 1619502275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in WI · 5071

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1705 16TH AVE, Cumberland, WI 54829

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, HealthPartners, Medica 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

Nicholas Pedersen 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 ID446674097

PECOS Enrollment IDI20200716000375

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

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

Cumberland Memorial Hospital

Critical Access Hospitals · Cumberland, WI

OwnershipVoluntary non-profit - Other

CMS Certification Number521353

Location1705 16th AveCumberland, WI 54829 · Barron County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54829 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

SARAH KATHERINE FARR FNP-C

Nurse Practitioner (Family)