Centennial Medical Group East, LLC
NPI 1699103598 · Rural Health Clinic/Center · Myrtle Creek, OR
Enrolled with Medicare as Part a Provider - Rural Health Clinic · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Centennial Medical Group East, LLC is a Rural Health Clinic/Center organization in Myrtle Creek, OR (NPI 1699103598).
Provider details
- NPI number
- 1699103598
- Entity type
- Organization
- Primary specialty
- Rural Health Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- Centennial Medical Group Dba Evergreen Family Medicine South
- Organization subpart
- Yes
- Authorized official
- Kim Tyree, Coo(541) 229-3332
- License
- 71216890 (OR)
Specialties & taxonomies
Ambulatory Health Care Facilities
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 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
Mailing address
Other names (DBA / former)
- Doing business as
- Evergreen Family Medicine South
Registry dates
- Enumerated
- 2013-10-31
- Last updated
- 2016-11-22
Frequently asked questions
- What is Centennial Medical Group East, LLC's NPI number?
- Centennial Medical Group East, LLC's National Provider Identifier (NPI) is 1699103598, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Centennial Medical Group East, LLC?
- Centennial Medical Group East, LLC is classified in the NPPES registry as Rural Health Clinic/Center (Ambulatory Health Care Facilities).
- Where is Centennial Medical Group East, LLC located?
- Centennial Medical Group East, LLC's practice location on file with NPPES is 145 Ne Broadway St, Myrtle Creek, OR 97457-9039.
- What is Centennial Medical Group East, LLC's phone number?
- The practice phone number listed in the NPPES registry for Centennial Medical Group East, LLC is (541) 863-3146.
- Does Centennial Medical Group East, LLC accept Medicare?
- Centennial Medical Group East, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Centennial Medical Group East, LLC?
- The authorized official listed on Centennial Medical Group East, LLC's NPPES record is Kim Tyree, Coo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Centennial Medical Group East, LLC's NPI active?
- Yes — Centennial Medical Group East, LLC's NPI (1699103598) is active in the NPPES registry as of the last update on 2016-11-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.