CENTENNIAL MEDICAL GROUP INC.
NPI 1518103274
Surgery in Roseburg, OR

Q: What is Centennial Medical Group Inc.'s NPI number?

The NPI number for Centennial Medical Group Inc. is 1518103274. It was assigned to this organization in the NPPES registry on December 31, 2008.

Q: What is Centennial Medical Group Inc.'s specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Active since December 31, 2008

201 NW MEDICAL LOOP STE 190, ROSEBURG, OR 97471(541) 644-4319(541) 677-2294 Get Directions Write a Review

NPPES record last updated: November 25, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 25, 2019, Aug 18, 2017 (2 updates tracked since 2017).

On this page

About Centennial Medical Group Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTENNIAL MEDICAL GROUP INC. (NPI 1518103274) is a healthcare organization registered as a surgery in Roseburg, Oregon and active in the NPI registry since December 2008. The organization lists Donna Raylene Van Dis, Credentialing Coordinator, as its authorized official.

NPPES Registry Identity

NPI1518103274

Entity TypeOrganization

Primary Taxonomy208600000X

Legal Business NameCENTENNIAL MEDICAL GROUP INC.

Location Address201 NW MEDICAL LOOP STE 190Roseburg, OR 97471-8835

Mailing Address201 Nw Medical Loop Ste 190Roseburg, OR 97471-8835 · (541) 644-4319 · Fax (541) 677-2294

Phone(541) 644-4319

Fax(541) 677-2294

Organization SubpartYes

Authorized OfficialDonna Raylene Van DisCredentialing Coordinator · (541) 677-4319

Enumeration DateDecember 31, 2008

Last NPPES UpdateNovember 25, 20192 updates tracked since enumeration

✔ NPI 1518103274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 8

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X

Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X

Also ListedInternal Medicine · Sleep MedicineTaxonomy 207RS0012X

Also ListedPathology · Clinical Pathology/Laboratory MedicineTaxonomy 207ZP0105X

Also ListedUrologyTaxonomy 208800000X

Also ListedHospitalistTaxonomy 208M00000X

201 NW MEDICAL LOOP STE 190, Roseburg, OR 97471

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Other Identifiers 1

Medicaid500601997OR

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 Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Centennial Medical Group Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 90 clinicians reassign Medicare billing to Centennial Medical Group Inc., which bills Medicare for the services they deliver. Of these, 4 practice at this address and 37 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 21

Cardiovascular Disease (Cardiology)14

Orthopedic Surgery8

Urology8

Gastroenterology7

Nurse Practitioner7

Interventional Cardiology6

Nephrology6

General Surgery5

13 other specialties29

Nearest to this location (20)

See all 90

Samantha Griffin, FNP

Nurse Practitioner

NPI 1952852568

277 NW MEDICAL LOOP
Roseburg, OR 97471

(541) 743-9003

✔ PECOS✔ Accepts MedicareSame address

Emily Armstrong, MD

Ophthalmology

NPI 1841780186

341 NW MEDICAL LOOP STE 120
Roseburg, OR 97471

(541) 440-6388

✔ PECOS✔ Accepts MedicareSame address

Lexa Van Volkenburg, OD

Optometry

NPI 1346920980

341 NW MEDICAL LOOP STE 120
Roseburg, OR 97471

(541) 672-8288

✔ PECOS✔ Accepts MedicareSame address

Alexander Willoughby

Ophthalmology

NPI 1093166191

341 NW MEDICAL LOOP STE 120
Roseburg, OR 97471

(541) 440-6388

✔ PECOS✔ Accepts MedicareSame address

Alejandro Diaz Chavez, M.D

Pulmonary Disease

NPI 1851731004

2460 NW STEWART PKWY STE 103
Roseburg, OR 97471

(541) 672-9515

✔ PECOS✔ Accepts Medicare0.1 mi

Bradley Seely, MD

Ophthalmology

NPI 1487636825

341 MEDICAL LOOP STE 120
Roseburg, OR 97471

(541) 440-6388

✔ PECOS0.1 mi

Razvan Gosman, MD

Pulmonary Disease

NPI 1407832868

2460 NW STEWART PKWY SUITE 103
Roseburg, OR 97471

(541) 672-9515

✔ PECOS✔ Accepts Medicare0.1 mi

Anjali Gupta, MD

Nephrology

NPI 1104074715

2460 NW STEWART PKWY SUITE 102
Roseburg, OR 97471

(541) 677-2494

✔ PECOS✔ Accepts Medicare0.1 mi

Robert Richardson, NP

Nurse Practitioner

NPI 1134845407

2460 NW STEWART PKWY STE 100
Roseburg, OR 97471

(541) 229-2663

✔ PECOS✔ Accepts Medicare0.1 mi

Micah Tovey, DPM

Podiatry

NPI 1053543967

2460 NW STEWART PKWY STE 100
Roseburg, OR 97471

(541) 229-2663

✔ PECOS✔ Accepts Medicare0.1 mi

Phillip Braunlich, D.O.

Orthopedic Surgery

NPI 1891143095

2460 NW STEWART PKWY STE 104
Roseburg, OR 97471

(541) 229-2663

✔ PECOS✔ Accepts Medicare0.1 mi

George Middlekauff, MD

Psychiatry

NPI 1598797664

2700 NW STEWART PARKWAY
Roseburg, OR 97471

(541) 677-2452

✔ PECOS✔ Accepts Medicare0.2 mi

Claire Pollard, MD

Pathology

NPI 1669637096

2700 NW STEWART PKWY
Roseburg, OR 97471

(520) 609-8870

✔ PECOS✔ Accepts Medicare0.2 mi

Ebelosele Aigbivbalu, MD

Pediatric Medicine

NPI 1164918108

2700 NW STEWART PARKWAY
Roseburg, OR 97471

(541) 677-2888

✔ PECOS0.2 mi

Ashiya Khan, MD

Cardiovascular Disease (Cardiology)

NPI 1346892049

2700 NW STEWART PKWY
Roseburg, OR 97471

(810) 342-5800

✔ PECOS✔ Accepts Medicare0.2 mi

Ciril Khorolsky, M.D.

Interventional Cardiology

NPI 1407309495

2700 NW STEWART PKWY
Roseburg, OR 97471

(541) 673-0611

✔ PECOS✔ Accepts Medicare0.2 mi

Dana Safavian, MD

Interventional Radiology

NPI 1922596139

2700 NW STEWART PKWY
Roseburg, OR 97471

(541) 673-0611

✔ PECOS✔ Accepts Medicare0.2 mi

Mukesh Thawani, M.D.

Hospitalist

NPI 1174716427

2700 NW STEWART PKWY
Roseburg, OR 97471

(541) 677-1527

✔ PECOS✔ Accepts Medicare0.2 mi

Jenni Nix, M.D.

General Surgery

NPI 1538543012

2801 NW MERCY DR STE 330
Roseburg, OR 97471

(541) 677-3600

✔ PECOS✔ Accepts Medicare0.2 mi

Gerald Engstrom, MD

Gastroenterology

NPI 1609851898

2510 NW EDENBOWER BLVD STE 112
Roseburg, OR 97471

(541) 464-6260

✔ PECOS0.3 mi

See all 90 clinicians

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 Inc.'s NPI number?

The NPI number for Centennial Medical Group Inc. is 1518103274. It was assigned to this organization in the NPPES registry on December 31, 2008.

Where is Centennial Medical Group Inc. located?

Centennial Medical Group Inc. is located at 201 NW Medical Loop Ste 190, Roseburg, OR 97471. The listed phone number is (541) 644-4319.

What is Centennial Medical Group Inc.'s specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Centennial Medical Group Inc. enrolled in Medicare?

Yes. Centennial Medical Group Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Centennial Medical Group Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 90 clinicians in 21 Medicare specialties reassign their Medicare billing to Centennial Medical Group Inc.. 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 Cardiovascular Disease (Cardiology) (14), Orthopedic Surgery (8) and Urology (8). Of these, 4 practice at this address and 37 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Centennial Medical Group Inc. accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and BridgeSpan Health Company and 2 other insurers list Centennial Medical Group Inc. 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 Inc. was last updated on November 25, 2019. 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.