Individual provider Active NPI

Jairus Sathianathan, MD

  • Internal Medicine Physician
  • Roseburg, OR
National Provider Identifier
1548226582
Registry record updated Jun 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD25568 Issued in OR
Practice address
1937 W Harvard Ave
Roseburg, OR 97471-2720
Phone
(541) 677-7200
Fax
(541) 229-3309
NPI assigned
Apr 26, 2006
Last updated
Jun 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD25568 OR Primary
Hospitalist Physician 208M00000X MD25568 OR

Addresses

Primary practice location

1937 W Harvard Ave
Roseburg, OR 97471-2720

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
844477029OtherORBCBS-GRANTS PASS
P00237173OtherORRAIL ROAD MEDICARE
838334026OtherORBCBS-ROSEBURG
838366027OtherORBCBS-MCMINNVILLE
026829MedicaidOR

Other names 1

  • Jairus Sathianathan Other name

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
I20050819000223 OR Practitioner - Internal Medicine 8921038837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD25568ORMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Medical Group East, LLC Current Accepting new patients
Centennial Medical Group East, LLC CurrentSince Oct 16, 2010 Accepting new patients

Locations

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

2510 NW Medical Park Dr
Roseburg, OR 97471
Phone (541) 440-9128

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

Organizations & group practices 3

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

Hospital & facility affiliations 3

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1548226582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 NW EDENBOWER BLVD.",
            "address_2": "SUITE 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": "SATHIANATHAN",
        "first_name": "JAIRUS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD25568",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD25568",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-GRANTS PASS",
            "identifier": "844477029",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00237173",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-ROSEBURG",
            "identifier": "838334026",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-MCMINNVILLE",
            "identifier": "838366027",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026829",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAIRUS",
            "last_name": "SATHIANATHAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.