NPIMap

Individual provider Active NPI

Raquel S Ristau, PAC

  • Physician Assistant
  • Waukon, IA
National Provider Identifier
1265934384
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
090856 Issued in IA
Practice address
120 2ND Ave SE
Waukon, IA 52172-2073
Phone
(563) 568-3000
NPI assigned
Mar 5, 2018
Last updated
Sep 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 090856 IA Primary

Addresses

Primary practice location

120 2ND Ave SE
Waukon, IA 52172-2073

Mailing address

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

Other practice location 1

40 1St St SE
Waukon, IA 52172-2022
Phone (563) 568-3411

Other identifiers 1

IdentifierTypeStateIssuer
1265934384MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20180404000764 IA Practitioner - Physician Assistant 7911260922 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
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
Gundersen Regional Clinics, LLCGroup PAC ID 8820450919, 51 clinicians

Practice addresses (Care Compare)

106 E Main
Calmar, IA 52132-7743
Phone (563) 562-3211

120 2ND Ave SE
Waukon, IA 52172-2073
Phone (563) 568-3000

1830 State Hwy 9
Suite 100
Decorah, IA 52101-7301
Phone (563) 382-3140

50 N 4TH St
Lansing, IA 52151-7729
Phone (563) 538-4874

901 Montgomery St
Decorah, IA 52101-2325
Phone (563) 382-2911

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
090856IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Apr 9, 2018 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Jun 30, 2018 Accepting new patients
Winneshiek Medical Center CurrentSince Sep 1, 2025 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Feb 1, 2026 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Jun 30, 2018 Accepting new patients
Winneshiek Medical Center Current Accepting new patients
Winneshiek Medical Center CurrentSince Sep 1, 2025 Accepting new patients
Palmer Lutheran Health Center, Inc. CurrentSince Jul 25, 2018 Accepting new patients
Gundersen Clinic, LTD. CurrentSince Apr 9, 2018 Accepting new patients
Gundersen Lutheran Medical Center, Inc. Past Accepting new patients
Gundersen Clinic LTD Past Accepting new patients
Winneshiek Medical Center Past Accepting new patients

Locations

235 8th Ave W
Cresco, IA 52136
Phone (319) 547-2101

1830 State Highway 9
Ste 100
Decorah, IA 52101
Phone (563) 382-3140

901 Montgomery St
Decorah, IA 52101
Phone (319) 382-2911

120 2nd Ave SE
Waukon, IA 52172
Phone (563) 568-3000

40 1st St SE
Waukon, IA 52172
Phone (563) 568-3411

112 Jefferson St
West Union, IA 52175
Phone (563) 422-3811

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

Interoperability endpoints

  • Direct secure messaging: rristau287744@direct.emplifyhealth.org

Organizations & group practices 14

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.

View all 14

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": "1520208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1265934384",
    "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": "120 2ND AVE SE",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521722073",
            "telephone_number": "563-568-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 1ST ST SE",
            "address_purpose": "LOCATION",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521722022",
            "country_code": "US",
            "telephone_number": "563-568-3411",
            "fax_number": "563-568-6139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RISTAU",
        "first_name": "RAQUEL",
        "middle_name": "S",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-05",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "090856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265934384",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukon, IA

Sources for this page

Verify at the official NPI Registry.