Clyde Richard Stephens, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9532 Issued in MN

Practice address

711 Delmore Dr
Roseau, MN 56751-1534

Phone

(218) 463-1365

NPI assigned

Jun 1, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakewood Health CenterGroup PAC ID 5698687929, shared by 5 NPIs, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakewood Health Center Hospital, Baudette, MN, CCN 241301
• Lakewood Health Center Nursing home, CCN 24Z301

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Lakewood Health Center

  dba CHI Lakewood Health

  • Critical Access Hospital
  • Baudette, MN
  • NPI 1922072776
  Medicare reassignment NPD
• Lakewood Health Center

  dba CHI Lakewood Health

  • Clinic/Center
  • Baudette, MN
  • NPI 1972799237
  Medicare reassignment NPD
• Altru Health System

  dba Altru Clinic Crookston

  • Clinic/Center
  • Crookston, MN
  • NPI 1760494330
  Medicare reassignment
• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095
  NPD
• Altru Health System

  dba Altru 1300 Columbia

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552
  NPD
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Lakewood Health Center

  dba LakeWood Health Center ARC

  • Assisted Living Facility
  • Baudette, MN
  • NPI 1548524648
  NPD (past)
• Lifecare Medical Center

  dba Lifecare Clinic Warroad

  • Rural Health Clinic/Center
  • Warroad, MN
  • NPI 1619724077
  NPD (past)

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

• Lakewood Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Baudette, MN
  • NPI 1346215084

  Nursing home

  Care Compare affiliation
• Lakewood Health Center

  dba CHI Lakewood Health

  • Critical Access Hospital
  • Baudette, MN
  • NPI 1922072776
  Care Compare affiliation

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1114964780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 OLD HIGHWAY 11 E",
            "city": "GREENBUSH",
            "state": "MN",
            "postal_code": "567264128",
            "telephone_number": "218-782-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "CLYDE",
        "middle_name": "RICHARD",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Dawn Silas, MD
• David Simmons, PHARM.D, BCPS
• Jessica Lynn Simmons, MD
• Stephen Michael Speltz, MD
• Anna Stein, PSY.D., LP
• Nghi Trinh-Pham, D.D.S.
• Rekiyatu Lawal Ugboajah, MD
• Bryon D Vandewege, MD
• Lorris Galen Vatnsdal II
• Peter Lloyd Vatnsdal, O.D.

• Physician Assistant in Roseau, MN
• Providers in Roseau, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.