NPIMap

Organization Active NPI

Centennial Medical Group LLP

  • Interventional Pain Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1073619359
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
CENTENNIAL MEDICAL GROUP LLP
Practice address
4454 N Decatur Blvd
Las Vegas, NV 89130
Phone
(702) 507-0996
Fax
(702) 507-0992
NPI assigned
Sep 15, 2006
Last updated
Aug 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Authorized official

Name
Dr. David Lanzkowsky, M.D.NPI 1154427375
Title
Owner
Phone
(702) 839-1203

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X NU Primary

Addresses

Primary practice location

4454 N Decatur Blvd
Las Vegas, NV 89130

Mailing address

4454 N Decatur Blvd
Las Vegas, NV 89130-5286
Phone (702) 839-1203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, NM3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20070125000104 NV Part B Supplier - Clinic/Group Practice 6901807536 Receives reassigned benefits from 14 practitioners
Practice locations: Las Vegas, NV
O20231018003549 NV DME Supplier - Multi-Specialty - Physician 6901807536 Practice locations: Las Vegas, NV
O20250423001226 NM Part B Supplier - Clinic/Group Practice 6901807536 Receives reassigned benefits from 3 practitioners
Practice locations: Albuquerque, NM

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D1097817Centennial Medical Group LLP-N Decatur4454 N Decatur Blvd, Las Vegas, NV 89130Certificate of waiverApr 2, 2027

National Provider Directory

National Provider Directory

Locations

2110 E Flamingo Rd
Ste 330
Las Vegas, NV 89119

4454 N Decatur Blvd
Las Vegas, NV 89130
Phone (702) 507-0996

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534982400000",
    "number": "1073619359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4454 N DECATUR BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891305286",
            "telephone_number": "702-839-1203",
            "fax_number": "702-839-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4454 N DECATUR BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89130",
            "telephone_number": "702-507-0996",
            "fax_number": "702-507-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2018-08-23",
        "status": "A",
        "authorized_official_last_name": "LANZKOWSKY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-839-1203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.