EVERGREEN FAMILY MEDICINE SOUTH
NPI 1699103598
Clinic/Center - Rural Health in Myrtle Creek, OR
NPI Status: Active since October 31, 2013
Contact Information
145 NE BROADWAY ST
MYRTLE CREEK, OR
ZIP 97457
Phone: (541) 863-3146
Fax: (541) 863-3226
- Organization
- Clinic/Center
- Rural Health
- Accepts Insurance
- CLIA Number: 38D0627175
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-31-2027
About EVERGREEN FAMILY MEDICINE SOUTH
This page provides the complete NPI Profile along with additional information for Evergreen Family Medicine South, a primary care provider established in Myrtle Creek, Oregon operating as a Clinic/center, focusing in rural health . The healthcare provider is registered in the NPI registry with number 1699103598 assigned on October 2013. The practitioner's primary taxonomy code is 261QR1300X. The provider is registered as an organization and their NPI record was last updated 10 years ago. Evergreen Family Medicine South operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Evergreen Family Medicine South. The authorized official of this NPI record is Kim Tyree (Coo)
- NPI
- 1699103598
- Provider Legal Name
- CENTENNIAL MEDICAL GROUP EAST, LLC
- Other Organization Name
- EVERGREEN FAMILY MEDICINE SOUTH
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 145 NE BROADWAY ST MYRTLE CREEK, OR 97457
- Location Phone
- (541) 863-3146
- Location Fax
- (541) 863-3226
- Mailing Address
- 2801 NW MERCY DR SUITE 340 ROSEBURG, OR 97471
- Mailing Phone
- (541) 677-2494
- Mailing Fax
- (541) 863-3226
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 10-31-2013
- Last Update Date
- 11-22-2016
- Code Navigator
A primary care provider (PCP) like Evergreen Family Medicine South sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Rural Health
- Taxonomy Code
- 261QR1300X
- Type
- Ambulatory Health Care Facilities
- License State
- OR
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 71216890 (OR) |
| 2 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | (OR) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 383891 | MEDICARE OSCAR/CERTIFICATION (06) | OR |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D0627175
- Facility Type
- Physician Office
- Certificate Effective Date
- January 01, 2026
- Certificate Expiration Date
- December 31, 2027
- Laboratory Director
- TIMOTHY J POWELL MD
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Evergreen Family Medicine South in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
Reviews for EVERGREEN FAMILY MEDICINE SOUTH
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1699103598, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 72. The final step is to find the difference between that total and the next multiple of ten (80 - 72 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 72 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 7 providers are registered at the same or a nearby location.
MYRTLE CREEK, OR 97457
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1699103598, enumerated as an "organization" on October 31, 2013.
The provider is located at 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 and the phone number is (541) 863-3146.
Clinic/Center with taxonomy code 261QR1300X and a focus in Rural Health.
The provider might be accepting Accepts: Moda Health Plan, Inc., Providence Health Plan,. Please consult your insurance carrier or call the provider to verify.
