NPIMap

Individual provider Active NPI

Robert John Laciak, M.D.

  • Urology Physician
  • Corvallis, OR
National Provider Identifier
1114196169
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD152679 Issued in OR
Practice address
990 NW Circle Blvd
Suite 102
Corvallis, OR 97330-1967
Phone
(541) 768-5486
NPI assigned
Feb 25, 2008
Last updated
Nov 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 6851346-1205 UT
Urology Physician 208800000X MD152679 OR Primary

Addresses

Primary practice location

990 NW Circle Blvd
Suite 102
Corvallis, OR 97330-1967

Mailing address

PO Box 1189
Corvallis, OR 97339-1189

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rlaciak5314@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120326000714 OR Practitioner - Urology 2062672264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Chicago College of Medicine and Surgery, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Good Samaritan Hospital CorvallisGroup PAC ID 1557270725, 372 clinicians

Practice addresses (Care Compare)

114 Gill Coliseum
RM 6263
Corvallis, OR 97331-8547
Phone (541) 737-4527

930 SW Abbey St
Newport, OR 97365-4820
Phone (541) 265-2244

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.23
Promoting interoperability
100
Improvement activities
40
Cost
100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6851346-1205UTMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince May 21, 2012 Accepting new patients
Samaritan Pacific Health Services, Inc CurrentSince Mar 7, 2016 Accepting new patients
Samaritan Pacific Health Services, Inc. Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince May 21, 2012 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Samaritan Pacific Health Services, Inc. CurrentSince Mar 7, 2016 Accepting new patients
Good Samaritan Hospital Corvallis Past Accepting new patients
Firstcare Medical Foundation PastSince Sep 1, 2004 Accepting new patients

Locations

114 Gill Coliseum
Rm 6263
Corvallis, OR 97331
Phone (541) 737-4527

3600 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 768-4906

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769

990 NW Circle Blvd
Ste 102
Corvallis, OR 97330
Phone (541) 768-5486

775 SW 9th St
Ste B
Newport, OR 97365
Phone (541) 265-2007

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

Interoperability endpoints

  • Direct secure messaging: rlaciak5314@samhealth.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1114196169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 NW CIRCLE BLVD",
            "address_2": "SUITE 102",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301967",
            "telephone_number": "541-768-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACIAK",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-25",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "6851346-1205",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "MD152679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rlaciak5314@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "990 NW Circle Blvd",
            "address_2": "Suite 102",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973301967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.