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EVERGREEN FAMILY MEDICINE SOUTH
NPI 1699103598
Clinic/Center - Rural Health in Myrtle Creek, OR

Active since October 31, 2013CLIA 38D0627175 · Microscopy
145 NE BROADWAY ST, MYRTLE CREEK, OR 97457(541) 863-3146(541) 863-3226 Get Directions Write a Review

NPPES record last updated: November 22, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Evergreen Family Medicine South NPPES

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

EVERGREEN FAMILY MEDICINE SOUTH (NPI 1699103598) is a healthcare organization registered as a rural health in Myrtle Creek, Oregon and active in the NPI registry since October 2013. The organization holds a CLIA Microscopy certificate valid through December 31, 2027 and lists Kim Tyree, Coo, as its authorized official.

NPPES Registry Identity

NPI1699103598
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameCENTENNIAL MEDICAL GROUP EAST, LLC
Location Address145 NE BROADWAY STMyrtle Creek, OR 97457-9039
Mailing Address2801 Nw Mercy Dr, Suite 340Roseburg, OR 97471-2348 · (541) 677-2494 · Fax (541) 677-2294
Phone(541) 863-3146
Fax(541) 863-3226
Organization SubpartYesParent: Centennial Medical Group Dba Evergreen Family Medicine South
Authorized OfficialKim TyreeCoo · (541) 229-3332
Enumeration DateOctober 31, 2013
Last NPPES UpdateNovember 22, 2016
✔ NPI 1699103598 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
Also ListedFamily MedicineTaxonomy 207Q00000X · License 71216890 (OR)
145 NE BROADWAY ST, Myrtle Creek, OR 97457
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Other Names 1

Doing Business AsEvergreen Family Medicine South

Other Identifiers 1

Medicare OSCAR/certification383891OR

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 Moda Health Plan, Inc., Providence Health Plan.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) 38D0627175

Cmg East Dba Evergreen Family Medicine South · Myrtle Creek, OR
Active · expires Dec 31, 2027
CLIA Number38D0627175
Laboratory TypePhysician Office
Certificate Effective DateJanuary 1, 2026
Certificate Expiration DateDecember 31, 2027
Laboratory DirectorTimothy J Powell MD
Laboratory Phone(541) 863-3146
Laboratory LocationCmg East Dba Evergreen Family Medicine South145 NE Broadway, Myrtle Creek, OR 97457
CLIA data matches this NPI record on: Address 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 7

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

KRISTINA A SKINNER FNP
Nurse Practitioner (Family)
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 863-3146
MRS. BARBARA A BERGERON FNP
Nurse Practitioner (Family)
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 863-3146
AMY L MARTIN
Community Health Worker
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 677-7200
TOM LIN MD
Family Medicine
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 677-7200
DR. JACQUELINE MARIE JOHNSON D.O.
Family Medicine
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 677-7200
KIMBERLLY JOY STEVENS FNP
Nurse Practitioner (Family)
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 677-7200
JESSICA PAIGE BARTLETT RN
Registered Nurse (Ambulatory Care)
145 NE BROADWAY ST
MYRTLE CREEK, OR 97457
Douglas County (541) 863-3146

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 1699103598. It was assigned to this organization in the NPPES registry on October 31, 2013.

Where is Centennial Medical Group East, LLC located?

Centennial Medical Group East, LLC is located at 145 NE Broadway St, Myrtle Creek, OR 97457. The listed phone number is (541) 863-3146.

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.

Does Centennial Medical Group East, LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 38D0627175) is associated with this NPI, valid through December 31, 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 Moda Health Plan, Inc. and 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 November 22, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.