Nicholas Pedersen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5071 Issued in WI

Practice address

1705 16TH Ave
Cumberland, WI 54829-8601

Phone

(715) 822-7500

Fax

(715) 822-7501

NPI assigned

Mar 4, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cumberland Memorial Hospital IncGroup PAC ID 7719889203, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cumberland Memorial Hospital Hospital, Cumberland, WI, CCN 521353

Merit-based Incentive Payment System (MIPS)

Final score

94.85 of 100Reported as group

Quality

89.04

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicholas.pedersen@cumberland-directmessage.com

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.

• Cumberland Memorial Hospital Inc

  • Critical Access Hospital
  • Cumberland, WI
  • NPI 1831243757

  Single Specialty, WI

  Medicare reassignment Care Compare group NPD (past)
• Cumberland Memorial Hospital, Inc

  • Community/Retail Pharmacy
  • Cumberland, WI
  • NPI 1093429821
  Care Compare group NPD
• Cumberland Memorial Hospital Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Cumberland, WI
  • NPI 1730233651
  Care Compare group
• Cumberland Memorial Hospital Inc

  • Rural Health Clinic/Center
  • Turtle Lake, WI
  • NPI 1952737264
  Care Compare group
• Cumberland Memorial Hospital Inc

  • Family Medicine Physician
  • Cumberland, WI
  • NPI 1861736472

  Single Specialty

  NPD

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

• Cumberland Memorial Hospital Inc

  • Critical Access Hospital
  • Cumberland, WI
  • NPI 1831243757

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1619502275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 16TH AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548298601",
            "telephone_number": "715-822-7500",
            "fax_number": "715-822-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 16TH AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548298601",
            "telephone_number": "715-822-7500",
            "fax_number": "715-822-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "NICHOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-04",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Nevala, PTA
• Jane Nickell, RN
• Kristin Ann Olson, RN
• Optima Natural Health & Wellness, LLC
• Harriet Ailene Osumi, OTR
• John Pulvino
• Ashley Regimbal, APNP
• Andrew Phillip Revak, DPT
• Jessica Richards, D.C.
• Jayne L Rieper, NP

• All providers in Cumberland, WI
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.