Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1093782914 Individual Practitioner Female Practitioner

Kimberly L Waller , PA-C

Physician Assistant • Grants Pass, OR

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Kimberly Waller, PA-C is a certified Physician Assistant practicing in Grants Pass, OR. With approximately 29 years of clinical experience since completing medical education in 1997, Kimberly Waller delivers high-quality medical care to the local community at 1701 NW HAWTHORNE AVE.

Kimberly Waller is affiliated with Siskiyou Community Health Center Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include hemoglobin a1c level, blood test, comprehensive group of blood chemicals, urine microalbumin (protein) analysis. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1701 Nw Hawthorne Ave

Grants Pass, OR 975261051

Telephone 5414713455
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

Other

Graduation Year

1997

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Grants Pass, OR

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
29 Yrs +20.5 yrs vs City Avg
City Avg: 8.5 Yrs
State Avg: 10.5 Yrs
Regional Practice Density
42 Specialists

Practicing in Grants Pass, OR (2106 Statewide)

Telehealth Adoption Rate
11.9% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
77.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Waller (29 Years) 29 Yrs
Grants Pass Specialty Average (8.5 Years) 8.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
83036 Hemoglobin A1C level
61 39 $41.00 $9.23
80053 Blood test, comprehensive group of blood chemicals
55 33 $46.00 $10.19
82044 Urine microalbumin (protein) analysis
33 25 $23.00 $5.95
80061 Blood test, lipids (cholesterol and triglycerides)
30 23 $57.00 $12.30
82570 Creatinine level to test for kidney function or muscle injury
28 22 $23.00 $4.92

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License OR PA01142

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

State License NV PA842

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
100503581 (NV)
Medicaid State Provider ID
100503226 (NV)

Hospital & Practice Group Affiliations

Siskiyou Community Health Center Inc

25647 Redwood Hwy, Cave Junction, OR 975239332

Phone: 5415924111

Siskiyou Community Health Center Inc

1701 Nw Hawthorne Ave, Grants Pass, OR 975261051

Phone: 5414724777

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

16 Associated Practitioners
Dr. Hala Ahmed , MD

Family Medicine

NPI 1013083609

Doctor of Medicine (M.D.)

Mona Kaahu , PMHNP

Nurse Practitioner - Psychiatric/Mental Health

NPI 1033884275

Psychiatric-Mental Health Nurse Practitioner

Paloma Kolkow

Nurse Practitioner - Family

NPI 1275081184
Kimberly Smith , APRN-NP

Nurse Practitioner - Family

NPI 1316628860

APRNNP

Shanna Pugh , PA-C

Physician Assistant - Medical

NPI 1326477589

Physician Assistant (Certified)

Bruce Towers , PA-C, MPAS, BBA

Physician Assistant - Medical

NPI 1346318789

Physician Assistant (Certified), MPAS, BBA

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 28, 2019

Physician Assistant (License #PA842 in NV)

NPI Profile Active September 13, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location September 13, 2017

Registered at 1701 NW HAWTHORNE AVE, GRANTS PASS, OR 975261051 (Tel: 5414713455)

📍
Updated Business Mailing Address September 13, 2017

Registered at 1701 NW HAWTHORNE AVE, GRANTS PASS, OR 975261051 (Tel: 5414713455)

👤
Provider Name / Credentials Updated September 13, 2017

Recorded as KIMBERLY WALLER, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 13, 2017

Physician Assistant (License #PA842 in NV)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 13, 2017

Physician Assistant (License #PA01142 in OR)

NPI Profile Active December 11, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location December 11, 2014

Registered at 700 SW RAMSEY AVE, SUITE 205, GRANTS PASS, OR 975275543 (Tel: 5415072140)

📍
Updated Business Mailing Address December 11, 2014

Registered at 2620 E BARNETT RD STE H, MEDFORD, OR 975048383 (Tel: 5417894281)

👤
Provider Name / Credentials Updated December 11, 2014

Recorded as KIMBERLY WALLER, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 11, 2014

Physician Assistant (License #PA01142 in OR)

🟢
Initial NPI Registration & Enumeration March 01, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093782914
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 01, 2006
Last Update: October 28, 2019
Sole Proprietor: No

Mailing Address

1701 Nw Hawthorne Ave

Grants Pass, OR 975261051

Phone: 5414713455

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.