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DR. LAZENI KOULIBALI D.O.
NPI 1063429777
Emergency Medicine in Salem, OR

Active since August 02, 2006PECOS Enrolled
665 WINTER ST SE, SALEM, OR 97301(503) 561-5634 Get Directions Write a Review

NPPES record last updated: December 19, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Lazeni Koulibali D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. LAZENI KOULIBALI D.O. (NPI 1063429777) is an individual emergency medicine provider in Salem, Oregon, licensed in Oregon (DO26795) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063429777
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameDR. LAZENI KOULIBALICredential: D.O.
Location Address665 WINTER ST SESalem, OR 97301-3919
Mailing AddressPo Box 2505Salem, OR 97308-2505 · (888) 828-3198
Phone(503) 561-5634
Sole ProprietorNo
Enumeration DateAugust 2, 2006
Last NPPES UpdateDecember 19, 2007
✔ NPI 1063429777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in OR · DO26795
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Also ListedFamily MedicineTaxonomy 207Q00000X · License DO26795 (OR)
665 WINTER ST SE, Salem, OR 97301
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Other Identifiers 5

Medicaid006030OR
Other006030Marion Polk Chp
Medicare PINP00349808
Medicare PINR135376
Medicaid8460313WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Lazeni Koulibali D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Lazeni Koulibali reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Salem Emergency Physicians Service, PC
0.1 mi
Emergency Medicine
890 OAK STREET, SE BUILDING 'A'
Salem, OR 97301
  • Reassigned Medicare billing, Oregon enrollment
  • 47 clinicians in this Medicare group
NPI 1063454395 (503) 561-5634
Salem Health West Valley
14 mi
Critical Access
525 SE WASHINGTON ST
Dallas, OR 97338
  • Reassigned Medicare billing, Oregon enrollment
  • 254 clinicians in this Medicare group
NPI 1245237486 (503) 623-8301

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
168 services163 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
124 services112 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
56 services55 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
50 services47 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97301 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.82 typical visit price
range $54.96 – $166.64
Typical copayment $21.20 (range $13.74 – $41.66)
Most-billed visit code 99203
Established Patient
$97.16 typical visit price
range $17.68 – $136.19
Typical copayment $24.29 (range $4.42 – $34.04)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PACIFIC PATHOLOGY ASSOCIATES, INC
Pathology (Anatomic Pathology & Clinical Pathology)
665 WINTER ST SE
SALEM, OR 97301
Marion County (503) 561-5350
DR. CHARLES WILSON MD
Emergency Medicine
665 WINTER ST SE
SALEM, OR 97301
Marion County (503) 561-5634
JIYOUN E KIM MD
Surgery
665 WINTER ST SE
SALEM, OR 97301
Marion County (503) 561-2448
COURTNEY E BROZOVICH PAC
Physician Assistant
665 WINTER ST SE
SALEM, OR 97301
Marion County (503) 541-2448
JAMES ERNEST DEVORSS MD
Internal Medicine (Cardiovascular Disease)
665 WINTER ST SE, SALEM HOSPITAL
SALEM, OR 97301
Marion County (503) 399-0811
MICHAEL BARR M.D.
Emergency Medicine
665 WINTER ST SE
SALEM, OR 97301
Marion County (503) 561-5634
SALEM HOSPITAL
General Acute Care Hospital (Children)
665 WINTER ST SE, FAMILY BIRTH CENTER 3RD FLOOR NEONATAL INTENSIVE CARE
SALEM, OR 97301
Marion County (503) 562-5660
DR. AUDREY T TRAINER D.O.
Emergency Medicine
665 WINTER ST SE
SALEM, OR 97301
Marion County (503) 561-5634

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lazeni Koulibali's NPI number?

The NPI number for Lazeni Koulibali is 1063429777. It was assigned to this individual provider in the NPPES registry on August 2, 2006.

Where is Lazeni Koulibali located?

Lazeni Koulibali practices at 665 Winter St SE, Salem, OR 97301. The listed phone number is (503) 561-5634.

What is Lazeni Koulibali's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Lazeni Koulibali enrolled in Medicare?

Yes. Lazeni Koulibali is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Lazeni Koulibali's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lazeni Koulibali reassigns Medicare benefits to 2 organizations: Salem Emergency Physicians Service, PC (Salem, OR) and Salem Health West Valley (Dallas, OR). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lazeni Koulibali's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Lazeni Koulibali accept?

Health plans from Moda Health Plan, Inc. list Lazeni Koulibali as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lazeni Koulibali was last updated on December 19, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.