NPIMap

Individual provider Active NPI

Emily Elizabeth Peterson, PA

  • Medical Physician Assistant
  • La Crosse, WI
National Provider Identifier
1023411626
Registry record updated Sep 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3391 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601-5429
Phone
(608) 782-7300
NPI assigned
Sep 27, 2014
Last updated
Sep 27, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3391 WI Primary

Addresses

Primary practice location

1836 South Ave
La Crosse, WI 54601-5429

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other names 1

  • Emily Elizabeth Mackey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141202000066 WI Practitioner - Physician Assistant 3375865330 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gundersen Clinic LTDGroup PAC ID 9638082779, 422 clinicians

Practice addresses (Care Compare)

1111 W Wisconsin St
Sparta, WI 54656-2233
Phone (608) 269-6731

1600 Main St
Onalaska, WI 54650-2838
Phone (608) 783-4681

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

1910 S Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300

2575 S 7TH St
Bethany Riverside
La Crosse, WI 54601-5429
Phone (608) 775-8200

407 S Main St
Viroqua, WI 54665-2100
Phone (608) 637-3195

505 Gopher Dr
Tomah, WI 54660-4513
Phone (608) 372-4111

507 S Main St
Viroqua, WI 54665-2059
Phone (608) 637-2101

610 E Taylor St
PR Du Chien, WI 53821-2109
Phone (608) 326-6466

705 Arena Dr
Viroqua, WI 54665-2059
Phone (608) 637-4362

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Oct 13, 2014 Accepting new patients
Gundersen Clinic, LTD. CurrentSince Oct 13, 2014 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Oct 13, 2014 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Oct 13, 2014 Accepting new patients
Gundersen Lutheran Medical Center, Inc. Past Accepting new patients
Gundersen Lutheran Medical Center Inc Past Accepting new patients
Gundersen Clinic LTD Past Accepting new patients

Locations

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466

Interoperability endpoints

  • Direct secure messaging: epeterson83056@direct.emplifyhealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411776000000",
    "number": "1023411626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "EMILY",
        "middle_name": "ELIZABETH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-27",
        "last_updated": "2014-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "MACKEY",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.