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

Q: 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.

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

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since March 21, 2023CLIA 38D0627341 · Microscopy

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: September 20, 2026.

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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 holds a CLIA Microscopy certificate valid through December 31, 2027 and 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 ›

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: 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.

Other Providers at the Same Location NPPES 9

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

MARTIN STEELE MD

Family Medicine