CENTENNIAL MEDICAL GROUP INC. (NPI# 1477962694) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477962694 |
| Entity Type | Organization |
| Organization Name | CENTENNIAL MEDICAL GROUP INC. |
| Other Organization Name | CENTENNIAL KIDNEY ASSOCIATES |
| Practice Address |
2460 Nw Stewart Pkwy Ste 102 Roseburg OR 97471-1516 |
| Mailing Address |
2801 Nw Mercy Dr Ste 340 Roseburg OR 97471-2348 |
| Practice Telephone | 5414646258 |
| Practice Fax Number | 5412290115 |
| Mailing Telephone | 5416774815 |
| Mailing Fax Number | 5416772294 |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2014-08-13 |
| 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 | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500671961 | 05 |
| Other Name | Type Code |
|---|---|
| Centennial Kidney Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518103274 | Centennial Medical Group Inc. | Internal Medicine | 201 Nw Medical Loop Ste 190, Roseburg, OR 97471-8835 | 2008-12-31 |
| 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 |
2460 NW STEWART PKWY STE 102 |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-1516 |
| 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 | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346394855 | Kidney and Hypertension Center PC | Internal Medicine | 2510 Nw Edenbower Blvd Ste 176, Roseburg, OR 97470-8899 | 2007-01-22 |
| 1104074715 | Anjali Gupta | Internal Medicine | 2460 Nw Stewart Pkwy, Suite 102, Roseburg, OR 97471-1516 | 2008-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396378717 | Northwest Renal Clinic, Inc. | Internal Medicine | 925 Commercial St Se Ste 110, Salem, OR 97302-4172 | 2020-02-13 |
| 1528487527 | Janie Luong | Internal Medicine | 10201 Se Main St Ste 27, Portland, OR 97216-2937 | 2014-04-08 |
| 1386074953 | David Alan Mccarron | Internal Medicine | 120 Nw 9th Ave, Suite 206, Portland, OR 97209-3324 | 2013-11-19 |
| 1578859849 | Thuy Xuan Le | Internal Medicine | 1040 Nw 22nd Ave Ste 480, Portland, OR 97210-3062 | 2011-06-24 |
| 1427348150 | Mark Nguyen | Internal Medicine | 1130 Nw 22nd Ave Ste 640, Portland, OR 97210-2993 | 2011-04-14 |
| 1720377039 | Robert Whitney Rope | Internal Medicine | 3181 Sw Sam Jackson Park Rd Mc Sjh6, Portland, OR 97239-3011 | 2011-04-07 |
| 1578707451 | Kate Schoolwerth Gustafson | Internal Medicine | 3710 Sw Us Veterans Hospital Rd # P3neph, Portland, OR 97239-2964 | 2009-04-23 |
| 1174777973 | Tricia Noelle Jesperson | Internal Medicine | 5050 Ne Hoyt St Ste B54, Portland, OR 97213 | 2008-11-06 |
| 1861677825 | Apolonia G. Silva | Internal Medicine | 6736 Ne Killingsworth Street La Clinica De Buena Salud, Portland, OR 97218-3338 | 2008-01-08 |
| 1396924999 | Northwest Renal Clinic, Inc. | Internal Medicine | 9701 Sw Barnes Road, Suite 110, Portland, OR 97225 | 2007-10-31 |
| Find all providers with the same taxonomy | ||||
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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.