1. Home
  2. Directory
  3. Oregon
  4. Roseburg
  5. Clinic Center
  6. NPI Profile

CENTENNIAL MEDICAL GROUP EAST, LLC
NPI 1235688805
Clinic/Center - Rural Health in Roseburg, OR

Active since September 23, 2016CLIA 38D2280627 · Waiver
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 01, 2026.

Record update history: Jan 7, 2019, Dec 22, 2016, Sep 23, 2016 (3 updates tracked since 2016).

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 1235688805) is a healthcare organization registered as a rural health in Roseburg, Oregon and active in the NPI registry since September 2016. The organization holds a CLIA Waiver certificate valid through April 23, 2027 and lists Kim Tyree, Coo, as its authorized official.

NPPES Registry Identity

NPI1235688805
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameCENTENNIAL MEDICAL GROUP EAST, LLC
Location Address1937 W HARVARD AVERoseburg, OR 97471-2720
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 SubpartNo
Authorized OfficialKim TyreeCoo · (541) 229-3332
Enumeration DateSeptember 23, 2016
Last NPPES UpdateMay 1, 20203 updates tracked since enumeration
NPPES CertifiedMay 1, 2020
✔ NPI 1235688805 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
License✔ Licensed in OR · 38-3896
Also ListedFamily MedicineTaxonomy 207Q00000X · License MD12182 (OR)
1937 W HARVARD AVE, Roseburg, OR 97471
Open in Google Maps ↗

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 Providence Health Plan.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.

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
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
Kolby Wade, CNM
Certified Nurse Midwife (CNM)
NPI 1407517931
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 of Waiver 38D2280627

Centennial Medical Group East Dba Evergreen Family Medicine North · Sutherlin, OR
Active · expires Apr 23, 2027
CLIA Number38D2280627
Laboratory TypeRural Health Clinic
Certificate Effective DateApril 24, 2025
Certificate Expiration DateApril 23, 2027
Laboratory DirectorTimothy J. Powell
Laboratory Phone(541) 229-3332
Laboratory LocationCentennial Medical Group East Dba Evergreen Family Medicine North249 Dakota Street, Sutherlin, OR 97479
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only 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 1235688805. It was assigned to this organization in the NPPES registry on September 23, 2016.

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 Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

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 of Waiver (number 38D2280627) is associated with this NPI, valid through April 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Centennial Medical Group East, LLC accept?

Health plans from Providence Health Plan 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 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.