Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Matthew T Stark, PA-C

Individual provider Medical Physician Assistant · NPI 1174700934

Matthew T Stark, PA-C is a Physician Assistant in Roseburg, Oregon. Qualified in 2009, 17 years ago. Practices with Centennial Medical Group East LLC, a 63-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
17
Licensed in
OR
In the registry since
2008
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1937 W Harvard Ave
Roseburg, OR 97471-2720
Phone: (541) 677-7200
Fax: (541) 229-3309
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X (OR)
Medical Physician Assistant Taxonomy 363AM0700X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1174700934
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 23, 2008
Last updated in NPPESJune 11, 2020
Certification dateJune 11, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Centennial Medical Group East Llc — 63 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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