CLYDE RICHARD STEPHENS PAC
NPI 1114964780
Physician Assistant in Roseau, MN
About Clyde Richard Stephens Pac NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CLYDE RICHARD STEPHENS PAC (NPI 1114964780) is an individual physician assistant in Roseau, Minnesota, licensed in Minnesota (9532) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Lakewood Health Center, and is a graduate of Other (2000).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Clyde Richard Stephens Pac is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Lakewood Health Center
Critical Access Hospitals · Baudette, MNPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 56751 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 15
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ROSEAU, MN 56751
ROSEAU, MN 56751
ROSEAU, MN 56751
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Clyde Stephens's NPI number?
The NPI number for Clyde Stephens is 1114964780. It was assigned to this individual provider in the NPPES registry on June 1, 2006.
Where is Clyde Stephens located?
Clyde Stephens practices at 711 Delmore Dr, Roseau, MN 56751. The listed phone number is (218) 463-1365.
What is Clyde Stephens's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Clyde Stephens enrolled in Medicare?
Yes. Clyde Stephens is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
What insurance does Clyde Stephens accept?
Health plans from Medica list Clyde Stephens as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Clyde Stephens affiliated with any hospitals?
According to CMS data, Clyde Stephens is affiliated with Lakewood Health Center.
When was this NPI record last updated?
The NPPES record for Clyde Stephens was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 34 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Clyde Richard Stephens, PAC · NPI 1114964780
Physician Assistant physician in Roseau, Minnesota. Individual provider, active in the CMS NPPES registry since June 1, 2006.
## Identity
- **NPI:** 1114964780 (Entity type: Individual)
- **Enumerated:** June 1, 2006
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **State license:** 9532 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 711 DELMORE DR, Roseau, MN 56751-1534
- **Phone:** (218) 463-1365
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2000
## Record status
- **NPPES last updated:** July 13, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1114964780) · Data from the CMS NPPES public registry.