Centennial Medical Group East, LLC
NPI 1134436637ActiveOrganization· Family Medicine· Roseburg, OR
Family Medicine in Roseburg, Oregon, registered in NPPES in September 2010, part of Centennial Medical Group, Inc. The authorized official on file is Kimberly Tyree, Coo. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1134436637 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Centennial Medical Group, Inc. |
| NPI issued | Sep 3, 2010 |
| Last updated in NPPES | Jul 1, 2025 |
| Certified by provider | Jul 1, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 71216890 | OR |
| Emergency Medicine | 207P00000X | 71216890 | OR |
| Physician Assistant | 363A00000X | 71216890 | OR |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (OR) |
|---|
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