NPIMap

Organization Active NPI

Centennial Medical Group West, LLC

  • Gastroenterology Physician
  • Roseburg, OR
National Provider Identifier
1891003497
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD15315 Issued in OR
Legal business name
CENTENNIAL MEDICAL GROUP WEST, LLC
Practice address
2801 NW Mercy Dr
Suite 345
Roseburg, OR 97471-2348
Phone
(541) 677-2494
Fax
(541) 677-2294
NPI assigned
Sep 16, 2010
Organization subpart
Yes
Parent organization
CENTENNIAL MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

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

Authorized official

Name
Rahul Agarwal
Title
President
Phone
(541) 677-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X MD15315 OR Primary

Addresses

Primary practice location

2801 NW Mercy Dr
Suite 345
Roseburg, OR 97471-2348

Mailing address

2801 NW Mercy Dr
Suite 340
Roseburg, OR 97471-2348
Phone (541) 677-2494

Other names 1

  • Gerald Engstrom, MD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Centennial Medical Group West LLC2 organizations share this tax ID, including this one
Part of
Centennial Medical Group

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1891003497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR",
            "address_2": "SUITE 340",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712348",
            "telephone_number": "541-677-2494",
            "fax_number": "541-677-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 NW MERCY DR",
            "address_2": "SUITE 345",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712348",
            "telephone_number": "541-677-2494",
            "fax_number": "541-677-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP WEST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTENNIAL MEDICAL GROUP, INC.",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "AGARWAL",
        "authorized_official_first_name": "RAHUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-677-2494"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD15315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gerald Engstrom, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.