OrganizationActive
Centennial Medical Group East, LLC
NPI 1134436637 · Family Medicine Physician · Roseburg, OR
Provider details
- NPI number
- 1134436637
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Centennial Medical Group, Inc.
- Organization subpart
- Yes
- Authorized official
- Kimberly Tyree, Coo(541) 229-3332
- License
- 71216890 (OR)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(83/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2570 Nw Edenbower Blvd
Roseburg, OR 97471-6214
Phone: (541) 677-2494
Fax: (541) 677-2294
Street-level locationGet directions
Mailing address
2570 Nw Edenbower Blvd
Roseburg, OR 97471-6214
Registry dates
- Enumerated
- 2010-09-03
- Last updated
- 2025-07-01
- Certified
- 2025-07-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.