CENTENNIAL MEDICAL GROUP WEST, LLC (NPI# 1063710192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063710192 |
| Entity Type | Organization |
| Organization Name | CENTENNIAL MEDICAL GROUP WEST, LLC |
| Other Organization Name | CENTENNIAL SURGICAL ASSISTANTS |
| Practice Address |
2700 Nw Stewart Pkwy Roseburg OR 97471-1281 |
| Mailing Address |
2801 Nw Mercy Dr Ste 340 Roseburg OR 97471-2348 |
| Practice Telephone | 5416772494 |
| Practice Fax Number | 5416772294 |
| Mailing Telephone | 5416772494 |
| Mailing Fax Number | 5416772294 |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2011-03-15 |
| Authorized Official Name | RAHUL AGARWAL (PRESIDENT) |
| Authorized Official Telephone | 5416772494 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTENNIAL MEDICAL GROUP, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Centennial Surgical Assistants | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245547744 | Centennial Medical Group West, LLC | Ophthalmology | 2801 Nw Mercy Dr., Ste. 340, Roseburg, OR 97471 | 2010-09-03 |
| 1891003497 | Centennial Medical Group West, LLC | Internal Medicine | 2801 Nw Mercy Dr, Suite 345, Roseburg, OR 97471-2348 | 2010-09-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP WEST, LLC | 201 Medical Loop, Suite 190, Roseburg, OR 97471 |
| Street Address |
2700 NW STEWART PKWY |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-1281 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790766822 | Mercy Healthcare, Inc | General Acute Care Hospital | 2700 Nw Stewart Pkwy, Roseburg, OR 97470-1281 | 2005-11-07 |
| 1902412505 | Lisa Mai | Physician Assistant | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1214 | 2020-09-18 |
| 1609480359 | Jacob Watters | Physician Assistant | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2020-09-01 |
| 1245843143 | Marcus Lee David Sickelton | Student in an Organized Health Care Education/Training Program | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1214 | 2020-08-28 |
| 1053978403 | Shelli Cross | Registered Nurse | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2019-05-21 |
| 1225695711 | Christa Lynne Creech | Pharmacist | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2019-05-21 |
| 1366007510 | Nikki Jean Whiting | Nurse Practitioner | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2019-05-03 |
| 1629554811 | Gary Sorcher | Physician Assistant | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2018-07-11 |
| 1548756158 | Timothy Lawrence Garvey Jr. | Physician Assistant | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2018-07-06 |
| 1437645223 | Kimberly Ann Romano | Registered Nurse | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2018-07-05 |
| Find all providers in the same location | ||||
| 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 | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427076751 | Timothy Ostrander | Physician Assistant | 2801 Nw Mercy Drive, Suite 330, Roseburg, OR 97471-2348 | 2006-07-17 |
| 1497751515 | Chenelle D Mccaskill | Physician Assistant | 2570 Nw Edenbower Blvd, Ste 100, Roseburg, OR 97471 | 2005-06-23 |
| 1417252990 | Benjamin James Baird | Physician Assistant | 2460 Nw Stewart Pkwy, Ste 100, Roseburg, OR 97471-1516 | 2011-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619575008 | Janna Marie Check | Physician Assistant | 3555 Chad Drive, Eugene, OR 97408 | 2020-10-16 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1396250122 | Saron Theresa Sufuentes | Physician Assistant | 578 Nw Marlborough Ave, Portland, OR 97210-3104 | 2017-12-01 |
| 1801321039 | Devin Fleming | Physician Assistant | 22936 Ne Pike St, Troutdale, OR 97060-2615 | 2017-04-25 |
| 1710435011 | Alexander Andersen | Physician Assistant | 445 Harlow Rd Ste 200, Springfield, OR 97477-1341 | 2016-09-14 |
| 1952775520 | Lauren Govier | Physician Assistant | 501 N Graham St Ste 415, Portland, OR 97227-2006 | 2015-11-19 |
| 1619346368 | Ryan Mcmahon | Physician Assistant | 3415 Ne 20th Ave, Portland, OR 97212-2416 | 2015-09-23 |
| 1518366863 | Latoya Allen | Physician Assistant | 2450 Highgate St, Unit 12, Medford, OR 97501-7955 | 2014-08-21 |
| 1528499910 | Elan Kennedy | Physician Assistant | 3181 Sw Sam Jackson Park Rd., Mail Code L353, Ohsu, Division of Cardiothoracic Surgery, Portland, OR 97239 | 2013-12-10 |
| 1699114421 | Lauren M Kendall | Physician Assistant | 960 N 16th St Ste 108, Springfield, OR 97477-4175 | 2013-06-14 |
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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.