Roosevelt Smith Jr., PAC, ATR

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9155 Issued in MN

Practice address

62 E 3Rd St
Suite 3
Winona, MN 55987-3481

Phone

(507) 474-4770

Fax

(507) 474-4774

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

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, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Winona Health ServicesGroup PAC ID 8527977420, 160 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Winona Health Services Hospital, Winona, MN, CCN 240044

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Winona Health Services

  • General Acute Care Hospital
  • Winona, MN
  • NPI 1295789352
  Medicare reassignment Care Compare group
• Nsu Inc

  • Physician Assistant
  • Winona, MN
  • NPI 1326064908
  NPD (past)
• Nsu Inc

  • Medical Physician Assistant
  • Onalaska, WI
  • NPI 1871630947
  NPD (past)

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

• Winona Health Services

  • General Acute Care Hospital
  • Winona, MN
  • NPI 1295789352
  Care Compare affiliation

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003836701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 E 3RD ST",
            "address_2": "SUITE 3",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559873481",
            "telephone_number": "507-474-4770",
            "fax_number": "507-474-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 E 3RD ST",
            "address_2": "SUITE 3",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559873481",
            "telephone_number": "507-474-4770",
            "fax_number": "507-474-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ROOSEVELT",
        "name_suffix": "Jr.",
        "credential": "PAC, ATR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "9155",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "500023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0121686",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "679G2SM",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP32318",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell James Slagle, PHARMD
• Thomas Levering Smart, CRNA
• Emalee Smith
• Emma Jean Smith
• Nyna Nicole Smith
• Zoey Christin Smith
• Kathryn B Snodgrass, OTR/L
• Emily L Solhjem
• Chase Lee Sosalla, PHARM.D.
• Southeast Minnesota Sports Medicine & Orthopaedic Surgery Specialists

• Medical Physician Assistant in Winona, MN
• Providers in Winona, MN by specialty
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.