EVERGREEN FAMILY MEDICINE SOUTH
NPI 1699103598
Clinic/Center - Rural Health in Myrtle Creek, OR
NPI Status: Active since October 31, 2013
Contact Information
145 NE BROADWAY ST
MYRTLE CREEK, OR
ZIP 97457
Phone: (541) 863-3146
Fax: (541) 863-3226
- Organization
- Clinic/Center
- Rural Health
- Accepts Insurance
- CLIA Number: 38D2001337
- CLIA Cert. Type: Hospital
- CLIA Exp. Date: 10-19-2026
About EVERGREEN FAMILY MEDICINE SOUTH
This page provides the complete NPI Profile along with additional information for Evergreen Family Medicine South, a primary care provider established in Myrtle Creek, Oregon operating as a Clinic/center, focusing in rural health . The healthcare provider is registered in the NPI registry with number 1699103598 assigned on October 2013. The practitioner's primary taxonomy code is 261QR1300X. The provider is registered as an organization and their NPI record was last updated 9 years ago. Evergreen Family Medicine South operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Evergreen Family Medicine South. The authorized official of this NPI record is Kim Tyree (Coo)
- NPI
- 1699103598
- Provider Legal Name
- CENTENNIAL MEDICAL GROUP EAST, LLC
- Other Organization Name
- EVERGREEN FAMILY MEDICINE SOUTH
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 145 NE BROADWAY ST MYRTLE CREEK, OR 97457
- Location Phone
- (541) 863-3146
- Location Fax
- (541) 863-3226
- Mailing Address
- 2801 NW MERCY DR SUITE 340 ROSEBURG, OR 97471
- Mailing Phone
- (541) 677-2494
- Mailing Fax
- (541) 863-3226
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 10-31-2013
- Last Update Date
- 11-22-2016
- Code Navigator
A primary care provider (PCP) like Evergreen Family Medicine South sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Rural Health
- Taxonomy Code
- 261QR1300X
- Type
- Ambulatory Health Care Facilities
- License State
- OR
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 71216890 (OR) |
| 2 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | (OR) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Moda Health Affinity Bronze 7750 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- HSA Qualified 7100 Bronze - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 383891 | MEDICARE OSCAR/CERTIFICATION (06) | OR |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D2001337
- Facility Type
- Hospital
- Certificate Effective Date
- October 20, 2024
- Certificate Expiration Date
- October 19, 2026
- Laboratory Director
- DR. CLAIRE POLLARD
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Evergreen Family Medicine South on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 6 | 9 | 9 | 1 | 0 | 3 | 5 | 9 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 6 | 18 | 9 | 2 | 0 | 6 | 5 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 6 + 1 + 8 + 9 + 2 + 0 + 6 + 5 + 1 + 8 + 24 = 72 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 72 = 8 | 8 | ||||||||
The NPI number 1699103598 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 7 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1255744611 | KRISTINA A SKINNER FNP Individual | Nurse Practitioner (Family) | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 863-3146 |
| 1528054335 | MRS. BARBARA A BERGERON FNP Individual | Nurse Practitioner (Family) | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 863-3146 |
| 1740941376 | AMY L MARTIN Individual | Community Health Worker | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 677-7200 |
| 1952569956 | TOM LIN MD Individual | Family Medicine | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 677-7200 |
| 1083814099 | DR. JACQUELINE MARIE JOHNSON D.O. Individual | Family Medicine | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 677-7200 |
| 1851828511 | KIMBERLLY JOY STEVENS FNP Individual | Nurse Practitioner (Family) | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 677-7200 |
| 1952192189 | JESSICA PAIGE BARTLETT RN Individual | Registered Nurse (Ambulatory Care) | 145 NE BROADWAY ST MYRTLE CREEK, OR 97457 (541) 863-3146 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1699103598, enumerated in the NPI registry as an "organization" on October 31, 2013
The provider is located at 145 Ne Broadway St Myrtle Creek, Or 97457 and the phone number is (541) 863-3146
This medical organization specializes in Clinic/Center with taxonomy code 261QR1300X with a focus in Rural Health
The provider might be accepting Accepts: Moda Health Plan, Inc., Providence Health Plan,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 38D2001337 for a "hospital" facility with a CLIA Certificate of Accreditation. This is a CLIA certificate is issued on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on October 31, 2013. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.