Jeffrey Allan Koller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA218511 Issued in OR

Practice address

114 SE Church St
Sublimity, OR 97385-9424

Phone

(503) 769-2259

NPI assigned

Jan 31, 2024

Last updated

Dec 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Santiam Memorial HospitalGroup PAC ID 6103729751, 128 clinicians

Robert Olsen MD LLCGroup PAC ID 7517354517, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Santiam Hospital & Clinics Hospital, Stayton, OR, CCN 380056

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Physician Assistant

Practice roles

Locations

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

• Robert Olsen MD LLC

  dba Best Mind

  • Psychiatry Physician
  • Portland, OR
  • NPI 1902565930
  Medicare reassignment Care Compare group NPD (past)
• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Medicare reassignment Care Compare group NPD (past)
• Santiam Memorial Hospital

  dba Santiam Medical Associates

  • Rural Health Clinic/Center
  • Stayton, OR
  • NPI 1477909570
  NPD
• Santiam Memorial Hospital

  dba Santiam Health & Wellness Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stayton, OR
  • NPI 1801787171
  NPD

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

• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Care Compare affiliation
• Santiam Memorial Hospital

  • Ambulance
  • Stayton, OR
  • NPI 1962566752

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1215790639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 SE CHURCH ST",
            "city": "SUBLIMITY",
            "state": "OR",
            "postal_code": "973859424",
            "telephone_number": "503-769-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 SE CHURCH ST",
            "city": "SUBLIMITY",
            "state": "OR",
            "postal_code": "973859424",
            "telephone_number": "503-769-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "JEFFREY",
        "middle_name": "ALLAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-31",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA218511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jean Forrest, COTA
• Jeffrey J Gries, DMD
• Frank Christopher Herb, PTA
• Austin Forsythe Horn I
• Connie L Koczur
• Jamie Leach, RN
• Marquis Companies I Inc (Marquis Marian Estates)
• David C Neely II
• John V Rickman
• Santiam Memorial Hospital (Sublimity Medical Clinic)

• Physician Assistant in Sublimity, OR
• Providers in Sublimity, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2025; 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.