CENTENNIAL MEDICAL GROUP EAST, LLC
NPI 1164124111
Family Medicine in Sutherlin, OR
NPI Status: Active since March 21, 2023
Contact Information
249 DAKOTA ST
SUTHERLIN, OR
ZIP 97479
Phone: (541) 677-7200
Fax: (541) 229-3309
- Organization
- Family Medicine
- Accepts Insurance
- CLIA Number: 38D2280627
- CLIA Cert. Type: Rural Health Clinic
- CLIA Exp. Date: 04-23-2027
About CENTENNIAL MEDICAL GROUP EAST, LLC
This page provides the complete NPI Profile along with additional information for Centennial Medical Group East, Llc, a primary care provider established in Sutherlin, Oregon operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1164124111 assigned on March 2023. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated 3 years ago. Centennial Medical Group East, Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Kimberly Tyree (Chief Operating Officer)
- NPI
- 1164124111
- Provider Name
- CENTENNIAL MEDICAL GROUP EAST, LLC
- Entity Type
- Organization
- Location Address
- 249 DAKOTA ST SUTHERLIN, OR 97479
- Location Phone
- (541) 677-7200
- Location Fax
- (541) 229-3309
- Mailing Address
- 2570 NW EDENBOWER BLVD STE 100 ROSEBURG, OR 97471
- Mailing Phone
- (541) 677-7200
- Mailing Fax
- (541) 229-3309
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 03-21-2023
- Last Update Date
- 03-21-2023
- Code Navigator
A primary care provider (PCP) like Centennial Medical Group East, Llc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - EPO
- BridgeSpan Standard Gold Plan - EPO
- BridgeSpan Standard Silver Plan - EPO
- HSA Qualified 7500 Bronze - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- Bronze Essential 9000 With 4 Copay No Deductible Office Visits Individual Connect - EPO
- Bronze HSA 7000 Individual Connect - EPO
- Gold 2300 Individual Connect - EPO
- Regence Standard Bronze Plan Individual Connect - EPO
- Regence Standard Gold Plan Individual Connect - EPO
- Regence Standard Silver Plan Individual Connect - EPO
- Silver 6500 Individual Connect - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D2280627
- Facility Type
- Rural Health Clinic
- Certificate Effective Date
- April 24, 2025
- Certificate Expiration Date
- April 23, 2027
- Laboratory Director
- TIMOTHY J. POWELL
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Centennial Medical Group East, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1164124111, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 49. The final step is to find the difference between that total and the next multiple of ten (50 - 49 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 49 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 9 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164124111, enumerated as an "organization" on March 21, 2023.
The provider is located at 249 DAKOTA ST SUTHERLIN, OR 97479 and the phone number is (541) 677-7200.
Family Medicine with taxonomy code 207Q00000X.
The provider might be accepting Accepts: BridgeSpan Health Company, Providence Health Plan. Please consult your insurance carrier or call the provider to verify.
