Individual provider Active NPI

Christopher E Petersen, PA C

  • Physician Assistant
  • Galesville, WI
National Provider Identifier
1356323950
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1335 Issued in WI
Practice address
16812 S Main St
Galesville, WI 54630-7704
Phone
(608) 582-2025
NPI assigned
Nov 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 1335 WI Primary

Addresses

Primary practice location

16812 S Main St
Galesville, WI 54630-7704

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
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100322000162 WI Practitioner - Physician Assistant 4486789047 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
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)

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

16812 S Main St
Galesville, WI 54630-7704
Phone (608) 582-2025

500 N Holmen Dr
Suite 502
Holmen, WI 54636-7301
Phone (608) 782-7300

Hospital & facility affiliations

  • Aveanna Home Health Home health agency, Rochester, MN, CCN 248098
  • 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
1335WIMDMarriage & Family Therapist
001061IAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Medical Center, Inc CurrentSince Dec 15, 2014 Accepting new patients
Gundersen Clinic LTD CurrentSince Dec 15, 2014 Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Dec 15, 2014 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Dec 15, 2014 Accepting new patients
Gundersen Clinic, LTD. Past Accepting new patients

Locations

1400 W Main St
Mc Gregor, IA 52157
Phone (563) 873-1366

105 E Main St
Waukon, IA 52172
Phone (319) 568-3449

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

Interoperability endpoints

  • Direct secure messaging: cpetersen89123@direct.emplifyhealth.org

Organizations & group practices 6

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.

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": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1356323950",
    "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": "16812 S MAIN ST",
            "city": "GALESVILLE",
            "state": "WI",
            "postal_code": "546307704",
            "telephone_number": "608-582-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CHRISTOPHER",
        "middle_name": "E",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesville, WI

Sources for this page

Verify at the official NPI Registry.