Richard Lynn Koller, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD20333 Issued in OR

Practice address

2863 NW Crossing Dr Ste 100
Bend, OR 97701-7189

Phone

(541) 322-3570

NPI assigned

Jul 14, 2005

Last updated

Sep 12, 2013By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Bend Memorial Clinic PC

  dba Bend Memorial Clinic PC dba Summit Health

  • Clinical Medical Laboratory
  • Bend, OR
  • NPI 1972144913
  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1255330031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2863 NW CROSSING DR STE 100",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017189",
            "telephone_number": "541-322-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "RICHARD",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD20333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01060391",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150158",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Marie Koenig, L.P.N.
• Jason Larry Koerner, MD
• Erica Kokkeler, CFNC
• Susan Kolb, MS, LPC
• Kevin J Kolcun, PA
• Dylan Konkle, D.C.
• David Koonce, LMT
• Tonya I Koopman, NP
• Taylor Kopecky, DPT
• Ellyn M Kornfeind, MD

• Neurology Physician in Bend, OR
• Providers in Bend, OR by specialty
• Neurology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.