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

Individual provider Medical Physician Assistant · NPI 1003836701

Roosevelt Smith Jr., PAC, ATR is a Physician Assistant in Winona, Minnesota. Qualified in 1981, 45 years ago. Practices with Winona Health Services, a 161-clinician group and accepts Medicare assignment. Licensed in Minnesota and Wisconsin.

Years since qualifying
45
Licensed in
MN, WI
In the registry since
2006
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

62 E 3rd St Ste 3
Winona, MN 55987-3481
Phone: (507) 474-4770
Fax: (507) 474-4774
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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 9155 (MN)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 500023 (WI)

Record details

NPI number1003836701
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC , ATR
Sole proprietorNo
NPI enumeratedJuly 19, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1981 (45 years in practice)
Group practice Winona Health Services — 161 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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