NPIMap

Organization Active NPI

Centennial Medical Group North, LLC

  • Orthopaedic Surgery Physician
  • Roseburg, OR
National Provider Identifier
1063722262
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
CENTENNIAL MEDICAL GROUP NORTH, LLC
Practice address
2801 NW Mercy Dr Ste 340
Roseburg, OR 97471-2348
Phone
(541) 677-2494
Fax
(541) 677-2294
NPI assigned
Oct 21, 2010
Organization subpart
Yes
Parent organization
CENTENNIAL MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rahul Agarwal
Title
President
Phone
(541) 677-2494

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Surgery of the Spine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0117X

Addresses

Primary practice location

2801 NW Mercy Dr Ste 340
Roseburg, OR 97471-2348

Mailing address

2801 NW Mercy Dr Ste 340
Roseburg, OR 97471-2348
Phone (541) 677-2494

Other identifiers 1

IdentifierTypeStateIssuer
500630863MedicaidOR

National Provider Directory

National Provider Directory
Part of
Centennial Medical Group Inc

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1063722262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR STE 340",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712348",
            "telephone_number": "541-677-2494",
            "fax_number": "541-677-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR STE 340",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712348",
            "telephone_number": "541-677-2494",
            "fax_number": "541-677-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP NORTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTENNIAL MEDICAL GROUP, INC.",
        "enumeration_date": "2010-10-21",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "AGARWAL",
        "authorized_official_first_name": "RAHUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-677-2494"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500630863",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.