CENTENNIAL MEDICAL GROUP (NPI# 1073912010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1073912010 |
Entity Type | Organization |
Organization Name | CENTENNIAL MEDICAL GROUP |
Other Organization Name | CENTENNIAL PEDIATRICS |
Practice Address |
2579 Nw Edenbower Blvd Roseburg OR 97471-6220 |
Mailing Address |
2801 Nw Mercy Dr Ste 340 Roseburg OR 97471-2348 |
Practice Telephone | 5414644990 |
Practice Fax Number | 5412290120 |
Mailing Telephone | 5416774815 |
Mailing Fax Number | 5416772294 |
Enumeration Date | 2014-08-15 |
Last Update Date | 2014-08-15 |
Authorized Official Name | JASON GRAY (PRESIDENT) |
Authorized Official Telephone | 5416773629 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Centennial Pediatrics | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
1598926677 | Centennial Medical Group | Pain Medicine | 4640 W Craig Rd, N Las Vegas, NV 89032-2743 | 2008-06-20 |
1265664742 | Centennial Medical Group | Surgery | 2570 Nw Edenbower Blvd, Suite 101, Roseburg, OR 97471-6214 | 2009-08-17 |
1497993695 | Centennial Medical Group | Pathology | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2009-01-26 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP EAST, LLC | 2801 Nw Mercy Dr Ste 340, Roseburg, OR 97471-2348 |
Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP EAST, LLC | 2570 Nw Edenbower Blvd, Roseburg, OR 97471 |
System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP INC | 2700 Stewart Pkwy, Roseburg, OR 97471-1281 |
Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP NORTH, LLC | 201 Medical Loop Ste 190, Roseburg, OR 97471 |
Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP WEST, LLC | 201 Medical Loop, Suite 190, Roseburg, OR 97471 |
Oregon Corporations, Companies and Business Names | CENTENNIAL MEDICAL GROUP, INC. | 201 Medical Loop Suite 190, Roseburg, OR 97471 |
System for Award Management (SAM) Entities | CENTENNIAL MEDICAL GROUP, P.A. | 8186 Lark Brown Rd Ste 201, Elkridge, MD 21075-6434 |
Street Address |
2579 NW EDENBOWER BLVD |
City | ROSEBURG |
State | OR |
Zip Code | 97471-6220 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255520383 | Jay N. Gade, Md, Phd, PC | Dermatology | 2579 Nw Edenbower Blvd, Roseburg, OR 97470-6220 | 2007-10-15 |
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 | 208000000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427499367 | Elizabeth Bish Young | Pediatrics | 901 Bellwood Ln, Roseburg, OR 97471-9299 | 2013-07-08 |
1447421250 | North River Pediatrics, LLC | Pediatrics | 2589 Nw Edenbower Blvd, Roseburg, OR 97471-6220 | 2008-03-19 |
1700893674 | Jacquelyn Outcalt Groshong | Pediatrics | 201 Medical Loop Rd, Suite 170, Roseburg, OR 97471-8835 | 2006-08-02 |
1134136013 | Kidsdocs PC | Pediatrics | 201 Nw Medical Loop, #170, Roseburg, OR 97471-8821 | 2006-08-02 |
1508383282 | Cynthia Blinn Steele | Pediatrics | 150 Ne Kenneth Ford Dr, Roseburg, OR 97470-1042 | 2017-08-24 |
1871016352 | Akhila Arcot Vadivelan | Pediatrics | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2017-07-17 |
1255787362 | Adam Kanafani | Pediatrics | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2016-05-06 |
1871972141 | Ashley Schmieding | Pediatrics | 2700 Nw Stewart Pkwy, Roseburg, OR 97471 | 2015-05-20 |
1982043741 | Rashmitha Dachepally | Pediatrics | 2700 Nw Stewart Pkwy, Roseburg, OR 97471 | 2013-06-14 |
1518250711 | Elaine Carrasco Cornelio | Pediatrics | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2011-05-20 |
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.