NPIMap

Individual provider Active NPI

Jacob D Anderson, PA-S

  • Physician Assistant
  • Wausau, WI
National Provider Identifier
1689307670
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
798223 Issued in WI
Practice address
4202 Indian Springs Dr
Wausau, WI 54401-4961
Phone
(715) 216-7553
NPI assigned
Jul 6, 2022
Last updated
Jul 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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 798223 WI Primary

Addresses

Primary practice location

4202 Indian Springs Dr
Wausau, WI 54401-4961

Mailing address

4202 Indian Springs Dr
Wausau, WI 54401-4961

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20240923001879 WI Practitioner - Physician Assistant 9335680982 Reassigns benefits to 6 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

Practice addresses (Care Compare)

601 S Ctr Ave
Merrill, WI 54452-3404
Phone (715) 536-5511

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
798223WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Sep 18, 2024 Accepting new patients
The Howard Young Medical Center, Inc. CurrentSince Sep 18, 2024 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Sep 18, 2024 Accepting new patients
Aspirus Merrill Hospital & Clinics, Inc. CurrentSince Sep 18, 2024 Accepting new patients
Aspirus Eagle River Hospital, Inc. CurrentSince Sep 18, 2024 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Sep 18, 2024 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

201 Hospital Rd
Eagle River, WI 54521
Phone (715) 477-3000

601 S Center Ave
Merrill, WI 54452
Phone (715) 536-5511

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

240 Maple St
Woodruff, WI 54568
Phone (715) 356-8000

Organizations & group practices 9

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.

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": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1689307670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 INDIAN SPRINGS DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 INDIAN SPRINGS DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014961",
            "telephone_number": "715-216-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACOB",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PA-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-06",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "798223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.