Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jacob Kohl Pederson, APRNCNP

Individual provider Gerontology Nurse Practitioner · NPI 1770243727

Mr. Jacob Kohl Pederson, APRNCNP is a Nurse Practitioner in Fargo, North Dakota. Qualified in 2021, 5 years ago. Practices with St Marys Regional Health Center, a 188-clinician group and accepts Medicare assignment. Licensed in North Dakota.

Years since qualifying
5
Licensed in
ND
In the registry since
2021
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Practice location Address checks out

3000 32nd Ave S
Fargo, ND 58103-6132
Phone: (701) 364-8000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence R51672 (ND)

Record details

NPI number1770243727
Entity typeIndividual (Type 1)
GenderMale
Credentials APRNCNP
Sole proprietorNo
NPI enumeratedDecember 17, 2021
Last updated in NPPESDecember 17, 2021
Certification dateDecember 17, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice St Marys Regional Health Center — 188 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients194
Services billed 570 a service is one billed item, such as a visit, a test or a procedure
Average patient age75

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

  • Essentia Health Hospital · Fargo, ND
  • Essentia Health St Marys - Detroit Lakes Hospital · Detroit Lakes, MN

Colleagues at St Marys Regional Health Center

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 188 clinicians in the practice; 12 are shown here.

Other providers in Fargo