NPIMap

Organization Active NPI

Northwest Medical Homes, LLC

Doing business as Centennial Clinic

  • Family Medicine Physician
  • Springfield, OR
National Provider Identifier
1114396199
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHWEST MEDICAL HOMES, LLC
Doing business as
Centennial Clinic
Practice address
1800 Centennial Blvd
Springfield, OR 97477-4385
Phone
(541) 747-4300
Fax
(541) 284-5534
NPI assigned
Sep 18, 2015
Last updated
Mar 31, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST MEDICAL HOMES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Authorized official

Name
Dr. Mark Stanley Meyers, M.D.NPI 1548237316
Title
Partner/ Officer
Phone
(541) 747-4300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1800 Centennial Blvd
Springfield, OR 97477-4385

Mailing address

2280 Marcola Rd
Springfield, OR 97477-2594
Phone (541) 747-4300

Other names 3

  • Centennial Clinic Doing business as
  • Springfield Family Physicians, LLP Former legal business name
  • Centennial SFP Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318001338 OR Part B Supplier - Clinic/Group Practice 0042100372 Receives reassigned benefits from 48 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, OR; Eugene, OR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Jonathan B Stout MD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BEGCAA

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1114396199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2280 MARCOLA RD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772594",
            "telephone_number": "541-747-4300",
            "fax_number": "541-284-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 CENTENNIAL BLVD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774385",
            "telephone_number": "541-747-4300",
            "fax_number": "541-284-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MEDICAL HOMES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST MEDICAL HOMES, LLC",
        "enumeration_date": "2015-09-18",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "MEYERS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "PARTNER/ OFFICER",
        "authorized_official_telephone_number": "541-747-4300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centennial Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Springfield Family Physicians, LLP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Centennial SFP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.