Centennial Medical Group LLP
Organization Active NPI Durable Medical Equipment & Medical Supplies · Albuquerque, NM
NPI 1740170091 · NPPES record last updated Jul 8, 2025
Key facts
- NPI
- 1740170091
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- Legal business name
- CENTENNIAL MEDICAL GROUP LLP
- Practice address
- 7800 Constitution Ave NE
Albuquerque, NM 87110-7552 - Phone
- (505) 296-6565
- NPI assigned
- Jul 8, 2025
- Organization subpart
- No
Authorized official
- Name
- Kellie Merrill
- Title
- Director of Billing
- Phone
- (702) 839-1203
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 10
-
John V Watkins, M.D.
-
Andrew Levi Blythe, PA-C
-
Latasha S Davis, APRN
-
David L Klappholz, CRNA
-
Daniel Robert Krauchuk, D.O.
-
Robert Sawyer, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D2323810 | Centennial Medical Group Dba Centenial Spine | Certificate of waiver | May 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250724000650 | NM | DME Supplier - Physician - Interventional Pain Management | 6901807536 | Practice locations: Albuquerque, NM |
National Provider Directory
- Tax ID family
- Centennial Medical Group LLP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Yes |
Addresses
Primary practice location
7800 Constitution Ave NE
Albuquerque, NM 87110-7552
Mailing address
4454 N Decatur Blvd
Las Vegas, NV 89130-5286
Phone (702) 893-1203
Other providers in Albuquerque, NM
- Juan Ceniceros
- Kimberly Branch Ceniceros
- Nicole Centazzo
- Leandro Xavier Centenera
- Luis Centenera
- Center for Creative Studies LLC
- Center for Creative Studies LLC
- Center for Holistic Health LLC
- Center for Prenatal Development
- Center for Reproductive Medicine of New Mexico
All providers in Albuquerque, NM · Durable Medical Equipment & Medical Supplies in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.