Amy Samantha Peck

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

201907329NP-PP Issued in OR

Practice address

12710 SE Division St
Portland, OR 97236-3134

Phone

(503) 988-3601

NPI assigned

Aug 20, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Multnomah County

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1609914787
  Medicare reassignment NPD
• Multnomah County

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1912226325
  NPD
• Multnomah County

  • Federally Qualified Health Center (FQHC)
  • Gresham, OR
  • NPI 1912322074
  NPD

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

{
    "created_epoch": "1566259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1174170682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4222 NE CLEVELAND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972112704",
            "telephone_number": "503-866-2746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12710 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363134",
            "telephone_number": "503-988-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "AMY",
        "middle_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-20",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "201907329NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Leigh Peats, PMHNP
• Deziare Pebenito, LMT
• Sean Paul Pebler, CADC
• Mark Pechovnik, LCSW
• Gabriel Adrian Peck-Frame, DO
• Ashley Peck
• Cynthia Jean Peck
• Elizabeth Joann Peck, DPT
• Gretli Peck, MSW
• James J Peck, M.D.

• Primary Care Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Primary Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.