CENTENNIAL MEDICAL GROUP EAST, LLC
NPI 1164124111
Family Medicine in Sutherlin, OR
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
Specialties & Licenses
Other Names 1
Group Practice 1
Accepted Insurance
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.
Clinicians Billing Medicare Through This Organization
61Medicare enrollment records show 61 clinicians reassign Medicare billing to Centennial Medical Group East, LLC, which bills Medicare for the services they deliver. Of these, 5 practice at this address. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 12
Nearest to this location (20)
See all 61Roseburg, OR 97471
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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, 5 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
# Centennial Medical Group East, Llc · NPI 1164124111
Family Medicine organization in Sutherlin, Oregon. Organization record, active in the CMS NPPES registry since March 21, 2023.
## Identity
- **NPI:** 1164124111 (Entity type: Organization)
- **Enumerated:** March 21, 2023
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Also known as:** Evergreen Family Medicine North (Doing Business As)
- **Organization subpart:** Yes (part of Centennial Medical Group East, Llc)
- **Authorized official:** Kimberly Tyree, CHIEF OPERATING OFFICER
## Practice location
- **Address:** 249 DAKOTA ST, Sutherlin, OR 97479-9908
- **Phone:** (541) 677-7200 · **Fax:** (541) 229-3309
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Oregon, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 61 clinicians in 12 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (26), Nurse Practitioner (10), Mental Health Counselor (7); 5 practice at this address; [full list](https://npiprofile.com/npi/1164124111/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 21, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1164124111) · Data from the CMS NPPES public registry.