CENTENNIAL MEDICAL GROUP INC. (NPI# 1518103274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518103274 |
| Entity Type | Organization |
| Organization Name | CENTENNIAL MEDICAL GROUP INC. |
| Practice Address |
201 Nw Medical Loop Ste 190 Roseburg OR 97471-8835 |
| Practice Telephone | 5416444319 |
| Practice Fax Number | 5416772294 |
| Mailing Telephone | 5416444319 |
| Mailing Fax Number | 5416772294 |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2019-11-25 |
| Authorized Official Name | DONNA RAYLENE VAN DIS (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 5416774319 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTENNIAL MEDICAL GROUP INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500601997 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477962694 | Centennial Medical Group Inc. | Internal Medicine | 2460 Nw Stewart Pkwy Ste 102, Roseburg, OR 97471-1516 | 2014-08-13 |
| 1841370368 | Centennial Medical Group Inc. | Specialist | 1801 16th St # A, Bakersfield, CA 93301-5002 | 2006-10-17 |
| 1033365135 | Centennial Medical Group Inc. | Internal Medicine | 2801 Nw Mercy Dr Ste 300, Roseburg, OR 97471-2348 | 2008-08-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP INC | 2700 Stewart Pkwy, Roseburg, OR 97471-1281 |
| Street Address |
201 NW MEDICAL LOOP STE 190 |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-8835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164782728 | Brent L Soder | Surgery | 2801 Nw Mercy Dr Ste 330, Roseburg, OR 97471-2348 | 2012-05-16 |
| 1215106133 | Mercy Medical Center, Inc. | Surgery | 2700 Nw Stewart Parkway, Roseburg, OR 97471 | 2008-02-25 |
| 1992887103 | Eric A Soder | Surgery | 2570 Nw Edenbower #101, Roseburg, OR 97470-6214 | 2006-10-19 |
| 1457327058 | Paul C Kremser | Surgery | 489 Cherokee Ave, Roseburg, OR 97470-9534 | 2006-02-24 |
| 1013450287 | Mercy Medical Center, Inc. | Surgery | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2016-11-21 |
| 1538543012 | Jenni Lynne Nix | Surgery | 2801 Nw Mercy Dr Ste 330, Roseburg, OR 97471-2348 | 2015-07-15 |
| 1457695546 | Mark N Donovan | Surgery | 2801 Nw Mercy Dr Ste 330, Roseburg, OR 97471 | 2012-11-15 |
| 1265664742 | Centennial Medical Group | Surgery | 2570 Nw Edenbower Blvd, Suite 101, Roseburg, OR 97471-6214 | 2009-08-17 |
| 1356517098 | Bryan Michael Mcvay | Surgery | 2801 Nw Mercy Dr, Suite 330, Roseburg, OR 97471-6214 | 2008-05-02 |
| 1841463064 | Eric A. Soder, M.d.,p.c. | Surgery | 2570 Nw Edenbower Blvd, Suite 101, Roseburg, OR 97470-6214 | 2008-04-09 |
| Find all providers in ROSEBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.