EVERGREEN FAMILY MEDICINE
NPI 1821366071
Clinic/Center - Rural Health in Roseburg, OR
About Evergreen Family Medicine NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EVERGREEN FAMILY MEDICINE (NPI 1821366071) is a healthcare organization registered as a rural health in Roseburg, Oregon and active in the NPI registry since December 2011. The organization lists Jason Gray, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Accepted 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)
Evergreen Family Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date 2
Next revalidation due by January 31, 2027
This provider holds 2 Medicare enrollments with upcoming revalidation dates. 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.
Clinicians Billing Medicare Through This Organization
61Medicare enrollment records show 61 clinicians reassign Medicare billing to Evergreen Family Medicine, which bills Medicare for the services they deliver. Of these, 25 practice at this address and 50 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 12
Nearest to this location (20)
See all 61Roseburg, OR 97471
Roseburg, OR 97471
Roseburg, OR 97470
Roseburg, OR 97471
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 East, LLC's NPI number?
The NPI number for Centennial Medical Group East, LLC is 1821366071. It was assigned to this organization in the NPPES registry on December 2, 2011. The provider is doing business as Evergreen Family Medicine.
Where is Centennial Medical Group East, LLC located?
Centennial Medical Group East, LLC is located at 2570 NW Edenbower Blvd, 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), Centennial Medical Group East, LLC holds 2 Medicare enrollments with upcoming revalidation dates. The next is due by January 31, 2027 (Non-DME Part B, Oregon, Clinic/Group Practice). 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, 25 practice at this address and 50 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Centennial Medical Group East, LLC accept?
Health plans from Moda Health Plan, Inc. 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 February 6, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# Evergreen Family Medicine · NPI 1821366071
Rural Health organization in Roseburg, Oregon. Organization record, active in the CMS NPPES registry since December 2, 2011.
## Identity
- **NPI:** 1821366071 (Entity type: Organization)
- **Enumerated:** December 2, 2011
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Legal business name:** Centennial Medical Group East, Llc
- **Organization subpart:** Yes (part of Centennial Medical Group, Inc.)
- **Authorized official:** Jason Gray, PRESIDENT
## Practice location
- **Address:** 2570 NW EDENBOWER BLVD, Roseburg, OR 97471-6214
- **Phone:** (541) 677-7200 · **Fax:** (541) 229-3309
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Oregon, Clinic/Group Practice), next of 2 enrollments with upcoming dates · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 61 clinicians in 12 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (26), Nurse Practitioner (10), Mental Health Counselor (7); 25 practice at this address and 50 within 10 miles; [full list](https://npiprofile.com/npi/1821366071/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 6, 2013
- **Other identifiers:** Medicare OSCAR/certification 383880 (OR)
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Source: [NPI Profile](https://npiprofile.com/npi/1821366071) · Data from the CMS NPPES public registry.