DR. DEREK KOLLER (NPI# 1629338470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629338470 |
| Entity Type | Individual |
| Full Name | DR. DEREK KOLLER |
| Credential | M.D. |
| Practice Address |
6861 Lemongrass Loop Se Salem OR 97306-1474 |
| Practice Telephone | 3619024789 |
| Practice Fax Number | 3619024588 |
| Mailing Telephone | 3619024789 |
| Mailing Fax Number | 3619024588 |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2020-01-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 036151000 | IL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | ME142837 | FL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | S2376 | TX | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 55553 | AZ | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 17828 | NV | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 11453A | WY | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | M-14141 | ID | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD2018-016 | NM | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD186008 | OR | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD60818224 | WA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | DR.0059780 | CO | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MED-PHYS-L | MT | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 284778 | NY | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | A143337 | CA | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 17981 | HI | Allopathic & Osteopathic Physicians |
| Street Address |
6861 LEMONGRASS LOOP SE |
| City | SALEM |
| State | OR |
| Zip Code | 97306-1474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134609050 | Andrea P Merryman | Dental Assistant | 5135 Skyline Rd South, Salem, OR 97306 | 2018-08-20 |
| 1215470315 | Anthony Quoc Ngo | Nurse Practitioner | 5050 Skyline Village Loop, Salem, OR 97306 | 2016-11-22 |
| 1134521305 | Wendy Poling | Occupational Therapy Assistant | 1966 Madras St Se Apt 1082, Salem, OR 97306 | 2014-09-19 |
| 1659601045 | Monarch Medical Group LLC | Clinic/Center | 5686 Commercial St Se, Suite 100, Salem, OR 97306 | 2010-01-06 |
| 1316188006 | Judith A Mitchell | Physician Assistant | 4999 Skyline Rd. S., Salem, OR 97306 | 2009-03-10 |
| 1164685574 | Leon Chira | Pharmacist | 2431 Concomly Rd S, Salem, OR 97306 | 2008-07-07 |
| 1912175035 | Salem Clinic, PC | General Practice | 2531 Boone Road Se, Salem, OR 97306 | 2008-02-11 |
| 1326257486 | Robert Allen Long | Physical Therapist | 6250 Commercial St N.e., Salem, OR 97306 | 2007-05-22 |
| 1922137504 | Charlene Garbutt | Dental Assistant | 5135 Skyline Rd. S., Salem, OR 97306 | 2007-03-02 |
| 1417085747 | Michelle West | Dental Assistant | 5135 Skyline R S, Salem, OR 97306 | 2007-02-28 |
| Find all providers in zip 97306 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710373444 | Larry Bassinger | Family Medicine | 1300 Broadway St Ne Ste 104, Salem, OR 97301-1420 | 2015-04-09 |
| 1396144507 | Constance Johanson | Family Medicine | 3959 Croisan Creek Rd S, Salem, OR 97302-9474 | 2014-08-14 |
| 1457792699 | Sultan Seretis Bussey Hospitalist LLC | Family Medicine | 310 Route 45, Salem, NJ 08079-2064 | 2013-07-16 |
| 1962712927 | Paul Julian Perrin | Family Medicine | 525 Ferry St Se, Suite 203, Salem, OR 97301 | 2010-10-08 |
| 1326372558 | Robert Verne Bain | Family Medicine | 2280 Kuebler Road, South, Salem, OR 97302 | 2009-09-21 |
| 1902036320 | James A. Auerbach, M.d., P.C. | Family Medicine | 4747 Skyline Rd S, Suite 190, Salem, OR 97306-4200 | 2009-07-20 |
| 1033347430 | Jeanette Walker | Family Medicine | 5560 Witzel Rd Se, Salem, OR 97317-9142 | 2009-06-24 |
| 1871747188 | Carmelle Marie Andrine Constant | Family Medicine | 84 Highland Ave Ste 309, Salem, MA 01970-2733 | 2008-11-13 |
| 1518127927 | Mazen I Madhoun | Family Medicine | 3737 W Main St Ste 101, Salem, VA 24153-2073 | 2008-06-10 |
| 1295918910 | Michael W Kelber Md PC | Family Medicine | 2365 Grear St Ne, Salem, OR 97301-2747 | 2007-12-17 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.