Individual provider Active NPI

Pamela H Ellenburg, DO

  • Family Medicine Physician
  • Roseburg, OR
National Provider Identifier
1376936732
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO199675 Issued in OR
Practice address
1937 W Harvard Ave
Roseburg, OR 97471-2720
Phone
(541) 677-7200
Fax
(541) 229-3309
NPI assigned
Mar 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO199675 OR Primary

Addresses

Primary practice location

1937 W Harvard Ave
Roseburg, OR 97471-2720

Mailing address

2570 NW Edenbower Blvd Ste 100
Roseburg, OR 97471-6214
Phone (541) 677-7200

Other identifiers 1

IdentifierTypeStateIssuer
500782222MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200902000576 OR Practitioner - Family Practice 1355611054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centennial Medical Group East LLCGroup PAC ID 9234397878, 63 clinicians
Evergreen Family Medicine PCGroup PAC ID 3870485139, 55 clinicians

Practice addresses (Care Compare)

1937 W Harvard Ave
Roseburg, OR 97471-2720
Phone (541) 677-7200

2570 NW Edenbower Blvd
Roseburg, OR 97471-6214

Hospital & facility affiliations

  • Mercy Medical Center Hospital, Roseburg, OR, CCN 380027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Medical Group East, LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Centennial Medical Group East, LLC Family Medicine Current Accepting new patients
Centennial Medical Group East, LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients

Locations

1937 W Harvard Ave
Roseburg, OR 97471
Phone (541) 677-7200

2570 NW Edenbower Blvd
Ste 100
Roseburg, OR 97471
Phone (541) 677-7200

Interoperability endpoints

  • Direct secure messaging: pamela.anderson.1@1334.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1376936732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 NW EDENBOWER BLVD STE 100",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974716214",
            "telephone_number": "541-677-7200",
            "fax_number": "541-229-3309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1937 W HARVARD AVE",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712720",
            "telephone_number": "541-677-7200",
            "fax_number": "541-229-3309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBURG",
        "first_name": "PAMELA",
        "middle_name": "H",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-10",
        "last_updated": "2024-02-01",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO199675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500782222",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.