MR. JACOB KOHL PEDERSON APRN CNP
NPI 1770243727
Nurse Practitioner - Gerontology in Fargo, ND
About Mr. Jacob Kohl Pederson Aprn Cnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. JACOB KOHL PEDERSON APRN CNP (NPI 1770243727) is an individual gerontology provider in Fargo, North Dakota, licensed in North Dakota (R51672) and active in the NPI registry since December 2021. He is enrolled in Medicare PECOS, is affiliated with St Lukes Hospital, and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mr. Jacob Kohl Pederson Aprn Cnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Jacob Pederson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Graceville, MN 56240
- Reassigned Medicare billing, Minnesota enrollment
- 36 clinicians in this Medicare group
Longville, MN 56655
- Reassigned Medicare billing, Minnesota enrollment
- 224 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.
Areas of Expertise CMS Part B claims 5
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.
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
St Lukes Hospital
Acute Care Hospitals · Duluth, MNEssentia Health St Marys - Detroit Lakes
Acute Care Hospitals · Detroit Lakes, MNEssentia Health
Acute Care Hospitals · Fargo, NDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 58103 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
FARGO, ND 58103
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 Pederson's NPI number?
The NPI number for Jacob Pederson is 1770243727. It was assigned to this individual provider in the NPPES registry on December 17, 2021.
Where is Jacob Pederson located?
Jacob Pederson practices at 3000 32nd Ave S, Fargo, ND 58103. The listed phone number is (701) 364-8000.
What is Jacob Pederson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Jacob Pederson enrolled in Medicare?
Yes. Jacob Pederson is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Jacob Pederson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Pederson reassigns Medicare benefits to 2 organizations: Graceville Health Center (Graceville, MN) and Cuyuna Regional Medical Center (Longville, MN). 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 Pederson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jacob Pederson accept?
Health plans from Anthem Blue Cross and Blue Shield and Blue Cross Blue Shield of North Dakota list Jacob Pederson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Jacob Pederson affiliated with any hospitals?
According to CMS data, Jacob Pederson is affiliated with St Lukes Hospital, Essentia Health St Marys - Detroit Lakes and Essentia Health.
When was this NPI record last updated?
The NPPES record for Jacob Pederson was last updated on December 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mr. Jacob Kohl Pederson, APRN CNP · NPI 1770243727
Gerontology physician in Fargo, North Dakota. Individual provider, active in the CMS NPPES registry since December 17, 2021.
## Identity
- **NPI:** 1770243727 (Entity type: Individual)
- **Enumerated:** December 17, 2021
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **State license:** R51672 (North Dakota)
- **Sole proprietor:** No
## Practice location
- **Address:** 3000 32ND AVE S, Fargo, ND 58103-6132
- **Phone:** (701) 364-8000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Graceville Health Center (NPI 1982673620, Graceville, MN); Cuyuna Regional Medical Center (NPI 1861414518, Longville, MN) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** December 17, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1770243727) · Data from the CMS NPPES public registry.