NPIMap

Individual provider Active NPI

Cooper Marc Jackson

  • Medical Physician Assistant
  • La Crosse, WI
National Provider Identifier
1053013383
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
7930 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601-5429
Phone
(608) 782-7300
NPI assigned
Mar 20, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 7930 WI Primary
Student in an Organized Health Care Education/Training Program 390200000X

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241030001316 WI Practitioner - Physician Assistant 9335672260 Reassigns benefits to 4 organizations
I20260316000756 MN Practitioner - Physician Assistant 9335672260 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
Gundersen Lutheran Medical Center IncGroup PAC ID 2163331414, 888 clinicians
Gundersen Clinic LTDGroup PAC ID 9638082779, 422 clinicians
St Marys Medical CenterGroup PAC ID 6901706357, 91 clinicians
Essentia Health Virginia LLCGroup PAC ID 7810149002, 64 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
Duluth, MN 55811-5640
Phone (218) 786-5360

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

402 A W Lake St
Friendship, WI 53934-9699
Phone (608) 339-8471

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-3443

402 W Lake St
Friendship, WI 53934-9699
Phone (608) 339-3331

901 9TH St N
Virginia, MN 55792-2325
Phone (218) 741-3340

Hospital & facility affiliations

  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Essentia Health Virginia Hospital, Virginia, MN, CCN 240084
  • Gundersen Lutheran Medical Center Hospital, La Crosse, WI, CCN 520087

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7930WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Essentia Health Virginia, LLC CurrentSince Feb 23, 2026 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Feb 23, 2026 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Oct 21, 2024 Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Oct 21, 2024 Accepting new patients
St Mary'S Hospital of Superior CurrentSince Feb 23, 2026 Accepting new patients
St Marys Medical Center CurrentSince Feb 23, 2026 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Oct 21, 2024 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Feb 23, 2026 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Feb 23, 2026 Accepting new patients
Gundersen Clinic LTD CurrentSince Oct 21, 2024 Accepting new patients
St. Mary'S Medical Center CurrentSince Feb 23, 2026 Accepting new patients
Essentia Health Virginia, LLC Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

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

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

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 17

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

View all 17

Hospital & facility affiliations 12

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": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1053013383",
    "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": "JACKSON",
        "first_name": "COOPER",
        "middle_name": "MARC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-20",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "7930",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.