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CENTENNIAL MEDICAL GROUP EAST, LLC
NPI 1164124111
Family Medicine in Sutherlin, OR

Active since March 21, 2023
249 DAKOTA ST, SUTHERLIN, OR 97479(541) 677-7200(541) 229-3309 Get Directions Write a Review

NPPES record last updated: March 21, 2023. Verified against the NPPES registry weekly; last sync: August 02, 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 1164124111), doing business as Evergreen Family Medicine North, is a healthcare organization registered as a family medicine in Sutherlin, Oregon and active in the NPI registry since March 2023. The organization lists Kimberly Tyree, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1164124111
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCENTENNIAL MEDICAL GROUP EAST, LLC
Location Address249 DAKOTA STSutherlin, OR 97479-9908
Mailing Address2570 Nw Edenbower Blvd Ste 100Roseburg, OR 97471-6214 · (541) 677-7200 · Fax (541) 229-3309
Phone(541) 677-7200
Fax(541) 229-3309
Organization SubpartYes
Authorized OfficialKimberly TyreeChief Operating Officer · (541) 229-3332
Enumeration DateMarch 21, 2023
NPPES CertifiedMarch 21, 2023
✔ NPI 1164124111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
249 DAKOTA ST, Sutherlin, OR 97479
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Other Names 1

Doing Business AsEvergreen Family Medicine North

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Providence Health Plan, Regence BlueCross BlueShield of Oregon.Insurance ›

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHLEEN MARIE RIORDAN FNP
Nurse Practitioner (Family)
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
MARTIN STEELE MD
Family Medicine
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
CHRISTINA MICHELE CRANLEY
Physician Assistant
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
DUSTIN MEYERS MD
Family Medicine
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
LORRAINE MATICE CHW
Community Health Worker
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
HEIDI Y. LEE MD
Family Medicine
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
NATALIE MOFFETT MD
Family Medicine
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200
ZACHARY ALLEN FERRIS MA LPC
Counselor (Professional)
249 DAKOTA ST
SUTHERLIN, OR 97479
Douglas County (541) 677-7200

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 1164124111. It was assigned to this organization in the NPPES registry on March 21, 2023. The provider is doing business as Evergreen Family Medicine North.

Where is Centennial Medical Group East, LLC located?

Centennial Medical Group East, LLC is located at 249 Dakota St, Sutherlin, OR 97479. 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 Family Medicine with taxonomy code 207Q00000X.

What insurance does Centennial Medical Group East, LLC accept?

Health plans from BridgeSpan Health Company, Providence Health Plan and Regence BlueCross BlueShield of Oregon list Centennial Medical Group East, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Centennial Medical Group East, LLC was last updated on March 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.