Kimberly L Waller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01142 Issued in OR

Practice address

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051

Phone

(541) 471-3455

NPI assigned

Mar 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kimberly L Colpitts Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Siskiyou Community Health Center IncGroup PAC ID 6305747288, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002
• Sutter Coast Hospital Hospital, Crescent City, CA, CCN 050417
• Mercy Medical Center Hospital, Roseburg, OR, CCN 380027
• Curry General Hospital Hospital, Gold Beach, OR, CCN 381322

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kimberly.waller@jhie.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Siskiyou Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Grants Pass, OR
  • NPI 1427046903
  Medicare reassignment Care Compare group NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Care Compare affiliation
• Commonspirit Oregon

  • General Acute Care Hospital
  • Roseburg, OR
  • NPI 1477590198
  Care Compare affiliation
• Curry Health District

  • Critical Access Hospital Clinic/Center
  • Brookings, OR
  • NPI 1083656367
  Care Compare affiliation
• Curry Health District

  • Critical Access Hospital
  • Gold Beach, OR
  • NPI 1487696985
  Care Compare affiliation
• Sutter Coast Hospital

  • General Acute Care Hospital
  • Crescent City, CA
  • NPI 1457367062
  Care Compare affiliation
• Sutter Coast Hospital

  • General Practice Physician
  • Crescent City, CA
  • NPI 1700960267

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1093782914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-471-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-471-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KIMBERLY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA842",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503581",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503226",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "COLPITTS",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jackie Walker, LM, CPM
• Kathryn Ellen Walker
• Summerlynne Walker
• Christina K Wallace
• Kristina Marie Wallace, PA-C
• Walmart Inc.
• Jeri Lou Walsh
• Scott M. Walters, O.D.
• Jacob T Waltrip, LMT
• Paula Marie Warden, L. AC

• Physician Assistant in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.