Individual provider Active NPI

Paul Dennis Wacek, PAC

  • Physician Assistant
  • Salem, OR
National Provider Identifier
1093742041
Registry record updated Jun 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01087 Issued in OR
Practice address
875 Oak St SE
Suite 5020
Salem, OR 97301-3975
Phone
(503) 371-4044
Fax
(503) 371-4356
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01087 OR Primary

Addresses

Primary practice location

875 Oak St SE
Suite 5020
Salem, OR 97301-3975

Mailing address

847 NE 19TH Ave
Suite 300
Portland, OR 97232-2684
Phone (503) 963-2801

Other identifiers 1

IdentifierTypeStateIssuer
500605090MedicaidOR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20060302000171 OR Practitioner - Physician Assistant 6204842164 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
75.94
Promoting interoperability
100
Improvement activities
40
Cost
83.56

Merit-based Incentive Payment System (MIPS)

Final score
92 of 100Reported as group
Quality
84.7
Promoting interoperability
100
Improvement activities
40
Cost
79.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health CurrentSince Jul 1, 2015 Accepting new patients
Salem Health CurrentSince Jul 1, 2015 Accepting new patients

Locations

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

1049 Edgewater St NW
#150
Salem, OR 97304
Phone (503) 814-3343

875 Oak St SE
Ste 5020
Salem, OR 97301
Phone (503) 371-4044

Interoperability endpoints

  • Direct secure messaging: pwacek@yourcarecommunity.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434585600000",
    "number": "1093742041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "SUITE 5020",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-371-4044",
            "fax_number": "503-371-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACEK",
        "first_name": "PAUL",
        "middle_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2015-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500605090",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.