Marissa Pederson, DNP, APNP, FNP-C
Individual provider Active NPI Family Nurse Practitioner · La Crosse, WI
NPI 1447865142 · NPPES record last updated Sep 30, 2022
Key facts
- NPI
- 1447865142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 10360-33 (WI)
- Practice address
- 1910 South Ave
La Crosse, WI 54601-5467 - Phone
- (608) 782-7300
- NPI assigned
- Sep 10, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gundersen Lutheran Medical Center Inc
Practice addresses (Care Compare)
1910 S Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300
Hospital & facility affiliations
- Gundersen Lutheran Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221230002037 | WI | Practitioner - Nurse Practitioner | 4981074259 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10360-33 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gundersen Lutheran Medical Center Inc | Current | Accepting new patients | |
| Gundersen Lutheran Medical Center, Inc. | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center, Inc | Current |
Accepting new patients | |
| Breidenbach Family and Sports Chiropractic 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
3111 Gundersen Dr
Onalaska, WI 54650
Phone (608) 775-8100
Interoperability endpoints
- mpederson221369@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 10360-33 | WI | Yes |
Addresses
Primary practice location
1910 South Ave
La Crosse, WI 54601-5467
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other providers in La Crosse, WI
- Theodore M Peck
- Joseph Alexander Pecoraro
- Connor Pedersen
- Anders Bjorn Pederson
- Jacob Matthew Pederson
- Susan Marie Pederson
- Bette J Pedretti
- Tanya Lynn Pedretti
- Danielle Peeso-Shepard
- Alexandra Pehling
All providers in La Crosse, WI · Family Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.