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

Cooper Marc Jackson

Individual provider Medical Physician Assistant · NPI 1053013383

Cooper Marc Jackson is a Physician Assistant in LA Crosse, Wisconsin. Qualified in 2024, 2 years ago. Practices with Polinsky Medical Rehabilitation Center, a 380-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
2
Licensed in
WI
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

1836 S Ave
LA Crosse, WI 54601-5429
Phone: (608) 782-7300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 7930 (WI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1053013383
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 20, 2023
Last updated in NPPESOctober 22, 2024
Certification dateOctober 22, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Polinsky Medical Rehabilitation Center — 380 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

Other providers in LA Crosse