CENTENNIAL MEDICAL GROUP


Address: 2579 Nw Edenbower Blvd, Roseburg, OR 97471-6220
Phone: 5414644990

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208000000X Pediatrics Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Centennial Pediatrics Doing Business As Name - Organization

Other Provider IDs and Locations

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

Other Data Sources

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

Office Location

Street Address 2579 NW EDENBOWER BLVD
City ROSEBURG
State OR
Zip Code 97471-6220

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255520383 Jay N. Gade, Md, Phd, PC Dermatology 2579 Nw Edenbower Blvd, Roseburg, OR 97470-6220 2007-10-15

Providers in the same zip code

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 Information

Taxonomy Code 208000000X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City ROSEBURG
Zip Code 97471

Improve Information

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Dataset Information

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.

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