CENTENNIAL MEDICAL GROUP, INC,. (NPI# 1215183132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215183132 |
| Entity Type | Organization |
| Organization Name | CENTENNIAL MEDICAL GROUP, INC,. |
| Other Organization Name | ROSEBURG HOSPITALIST SERVICES |
| Practice Address |
2700 Nw Stewart Pkwy Roseburg OR 97471-1281 |
| Practice Telephone | 5416773629 |
| Practice Fax Number | 5416771554 |
| Mailing Telephone | 5416773629 |
| Mailing Fax Number | 5416771554 |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2009-01-22 |
| Authorized Official Name | MR. RAHUL S. AGARWAL (CORP SECRETARY) |
| Authorized Official Telephone | 5416773650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208M00000X | Hospitalist | 141133 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICARE PART B | R0000ZGBFM | 01 |
| Other Name | Type Code |
|---|---|
| Roseburg Hospitalist Services | Doing Business As Name - Organization |
| 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 |
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| 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 |
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| Taxonomy Code | 208M00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Hospitalist |
| Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. |
| Notes: Source: American Society of Hospital Medicine, 2007. http://www.hospitalmedicine.org/ [7/1/2009: definition aded] Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions. There is no board certification for the specialty at this point. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528375532 | Christine Yap Villardo | Hospitalist | 2801 Nw Mercy Dr, Suite 340, Roseburg, OR 97471-2348 | 2010-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912386616 | Hospitalists of Oregon | Hospitalist | 1193 Cedar Ridge Dr, Eugene, OR 97401-1916 | 2015-05-27 |
| 1083977417 | Katrina G Hoffman | Hospitalist | 4600 Evergreen Pl Se, Albany, OR 97322-6182 | 2012-06-20 |
| 1659547677 | Bassel Beitinjaneh | Hospitalist | 4984 Sw Oleson Rd, 27, Portland, OR 97225-1462 | 2008-04-30 |
| 1558532317 | Ee Lin Wan | Hospitalist | 2640 E Barnett Rd, #e-333, Medford, OR 97504-4301 | 2008-03-19 |
| 1972697522 | Mark Helfand | Hospitalist | Portland Vamc P3med, 3710 Sw Us Veterans Hospital Road, Portland, OR 97239 | 2006-10-03 |
| 1558468322 | Peter Damian Sullivan | Hospitalist | 3181 Sw Sam Jackson Park Rd # Bte119, Portland, OR 97239-3011 | 2006-09-20 |
| 1457461279 | Thomas William Barrett | Hospitalist | 3710 Sw Us Va Hospital Rd, Portland Vamc (p3med), Portland, OR 97207-1034 | 2006-08-30 |
| 1598241010 | Bernard Nicholas | Hospitalist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2018-07-17 |
| 1205338084 | Maricela Elena Bandel-ramirez | Hospitalist | 1700 E 19th St, The Dalles, OR 97058 | 2018-03-07 |
| 1114456217 | Temur Said | Hospitalist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2017-06-12 |
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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.