Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Dr. Derek Koller, MD

Individual provider Family Medicine Physician · NPI 1629338470

Dr. Derek Koller, MD is a Family Medicine Physician in Salem, Oregon. Practices as a sole proprietor. Licensed in Arizona, California, Colorado and Florida and 11 more.

Licensed in
AZ, CA, CO, FL, HI, ID
In the registry since
2012
Specialties on file
15
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

6861 Lemongrass Loop SE
Salem, OR 97306-1474
Phone: (361) 902-4789
Fax: (361) 902-4588
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 17981 (HI)
Family Medicine Physician Taxonomy 207Q00000X · Licence 284778 (NY)
Family Medicine Physician Taxonomy 207Q00000X · Licence M-14141 (ID)
Family Medicine Physician Taxonomy 207Q00000X · Licence MED-PHYS-LIC-60886 (MT)
Family Medicine Physician Taxonomy 207Q00000X · Licence A143337 (CA)
Family Medicine Physician Taxonomy 207Q00000X · Licence DR.0059780 (CO)
Family Medicine Physician Taxonomy 207Q00000X · Licence MD60818224 (WA)
Family Medicine Physician Taxonomy 207Q00000X · Licence MD186008 (OR)
Family Medicine Physician Taxonomy 207Q00000X · Licence MD2018-0164 (NM)
Family Medicine Physician Taxonomy 207Q00000X · Licence 17828 (NV)
Family Medicine Physician Taxonomy 207Q00000X · Licence 11453A (WY)
Family Medicine Physician Taxonomy 207Q00000X · Licence 55553 (AZ)
Family Medicine Physician Taxonomy 207Q00000X · Licence S2376 (TX)
Family Medicine Physician Taxonomy 207Q00000X · Licence ME142837 (FL)
Family Medicine Physician Taxonomy 207Q00000X · Licence 036151000 (IL)

Record details

NPI number1629338470
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMay 25, 2012
Last updated in NPPESJanuary 13, 2020
Certification dateJanuary 13, 2020

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients65
Services billed 71 a service is one billed item, such as a visit, a test or a procedure
Average patient age61

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

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