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

Jacob Timothy Wagner, DPM

Individual provider Podiatrist · NPI 1790304442

Jacob Timothy Wagner, DPM is a Podiatry in LA Crosse, Wisconsin. Qualified in 2020, 6 years ago. Practices with Ascension Medical Group-Southeast Wisconsin Inc, a 555-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
6
Licensed in
WI
In the registry since
2020
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

1836 S Ave
LA Crosse, WI 54601-5429
Phone: (608) 782-7300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Podiatrist (primary) Taxonomy 213E00000X · Licence 1303 (WI)

Record details

NPI number1790304442
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorNo
NPI enumeratedApril 13, 2020
Last updated in NPPESJanuary 13, 2023
Certification dateJanuary 13, 2023
Mailing address1836 South Ave, La Crosse, WI 54601-5429

Medicare enrollment

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

Medicare specialtyPODIATRY
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Ascension Medical Group-Southeast Wisconsin Inc — 555 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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