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CENTENNIAL MEDICAL GROUP EAST, LLC
NPI 1134243249
Obstetrics & Gynecology in Roseburg, OR

Active since March 16, 2007CLIA 38D0627341 · Microscopy
1937 W HARVARD AVE, ROSEBURG, OR 97471(541) 677-7200(541) 229-3309 Get Directions Write a Review

NPPES record last updated: May 1, 2020. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Centennial Medical Group East, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTENNIAL MEDICAL GROUP EAST, LLC (NPI 1134243249) is a healthcare organization registered as an obstetrics & gynecology in Roseburg, Oregon and active in the NPI registry since March 2007. The organization holds a CLIA Microscopy certificate valid through December 31, 2027 and lists Kimberly Tyree, Coo, as its authorized official.

NPPES Registry Identity

NPI1134243249
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NameCENTENNIAL MEDICAL GROUP EAST, LLC
Location Address1937 W HARVARD AVERoseburg, OR 97471-2720
Mailing Address2570 Nw Edenbower BlvdRoseburg, OR 97471-6214 · (541) 677-7200 · Fax (541) 677-7462
Phone(541) 677-7200
Fax(541) 229-3309
Organization SubpartNo
Authorized OfficialKimberly TyreeCoo · (541) 229-3332
Enumeration DateMarch 16, 2007
Last NPPES UpdateMay 1, 2020
NPPES CertifiedMay 1, 2020
✔ NPI 1134243249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1937 W HARVARD AVE, Roseburg, OR 97471
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Centennial Medical Group East, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateOregonEnrollment IDO20120228000510Non-DME Part B · Clinic/Group PracticeDue dateJanuary 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

61

Medicare enrollment records show 61 clinicians reassign Medicare billing to Centennial Medical Group East, LLC, which bills Medicare for the services they deliver. Of these, 21 practice at this address and 50 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 12

Family Practice26
Nurse Practitioner10
Mental Health Counselor7
Certified Nurse Midwife (CNM)3
Internal Medicine3
Obstetrics/Gynecology3
Endocrinology2
Hospitalist2
4 other specialties5

Nearest to this location (20)

See all 61
Kolby Wade, CNM
Certified Nurse Midwife (CNM)
NPI 1407517931
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Shelley Brittain, MD
Family Practice
NPI 1114995735
1937 W. HARVARD AVE.
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Anca Dauer, DO
Family Practice
NPI 1295269082
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Pamela Ellenburg, DO
Family Practice
NPI 1376936732
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Alyssa Emo, DO
Obstetrics/Gynecology
NPI 1811343155
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Stacie Hanna, CNM
Certified Nurse Midwife (CNM)
NPI 1639703549
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Ryan Melton, LPC
Mental Health Counselor
NPI 1851590400
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Emmanuel Okenye
Internal Medicine
NPI 1346777950
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Elizabeth Oler, M.D.
Obstetrics/Gynecology
NPI 1760894760
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Britain Parrish, MD
Family Practice
NPI 1255866489
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Mary Powell, MD
Obstetrics/Gynecology
NPI 1487727988
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Timothy Powell, MD
Family Practice
NPI 1689647844
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Jairus Sathianathan, MD
Internal Medicine
NPI 1548226582
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Danielle Schmidt, DO
Family Practice
NPI 1780260240
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Derek Wiseman, MD
Family Practice
NPI 1952988222
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Judy Black, M.D.
Pediatric Medicine
NPI 1770786667
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOSSame address
Natalie Groshong, MD
Internal Medicine
NPI 1952042939
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Vishal Kottapalli, DO
Family Practice
NPI 1053044610
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Dana Martin, CNM
Certified Nurse Midwife (CNM)
NPI 1124907472
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOS✔ Accepts MedicareSame address
Brandi Myers, BS
Mental Health Counselor
NPI 1770165631
1937 W HARVARD AVE
Roseburg, OR 97471
(541) 677-7200
✔ PECOSSame address
See all 61 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 38D0627341

Centennial Medical Group East · Roseburg, OR
Active · expires Dec 31, 2027
CLIA Number38D0627341
Laboratory TypePhysician Office
Certificate Effective DateJanuary 1, 2026
Certificate Expiration DateDecember 31, 2027
Laboratory DirectorTimothy J. Powell MD
Laboratory Phone(541) 677-7200
Laboratory LocationCentennial Medical Group East2570 NW Edenbower Blvd #100, Roseburg, OR 97471
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centennial Medical Group East, LLC's NPI number?

The NPI number for Centennial Medical Group East, LLC is 1134243249. It was assigned to this organization in the NPPES registry on March 16, 2007.

Where is Centennial Medical Group East, LLC located?

Centennial Medical Group East, LLC is located at 1937 W Harvard Ave, Roseburg, OR 97471. The listed phone number is (541) 677-7200.

What is Centennial Medical Group East, LLC's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Centennial Medical Group East, LLC enrolled in Medicare?

Yes. Centennial Medical Group East, LLC is registered in the Medicare PECOS enrollment system.

When is Centennial Medical Group East, LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Oregon, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Centennial Medical Group East, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 61 clinicians in 12 Medicare specialties reassign their Medicare billing to Centennial Medical Group East, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Family Practice (26), Nurse Practitioner (10) and Mental Health Counselor (7). Of these, 21 practice at this address and 50 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Centennial Medical Group East, LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 38D0627341) is associated with this NPI, valid through December 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centennial Medical Group East, LLC was last updated on May 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.