Individual provider Active NPI

Blair Peters

  • Plastic Surgery Physician
  • Portland, OR
National Provider Identifier
1871147876
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
2019011349 Issued in MO
Practice address
3181 SW Sam Jackson Park Rd # L352A
Portland, OR 97239-3011
Phone
(503) 494-7824
NPI assigned
Jul 29, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 2019011349 MO Primary
Plastic and Reconstructive Surgery Physician 2086S0122X 197514 OR

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd # L352A
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd # L352A
Portland, OR 97239-3011
Phone (503) 494-7824

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210810003236 OR Practitioner - Plastic and Reconstructive Surgery 1658775846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

3303 S Bond Ave
Portland, OR 97239-4501
Phone (503) 494-8311

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2019011349MOMDPlastic Surgery Physician
197514ORMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services Current Accepting new patients
University Professional Services CurrentSince Aug 1, 2021 Accepting new patients
University Professional Services CurrentSince Aug 1, 2021 Accepting new patients
Oregon Health & Science University Past Accepting new patients
University Professional Services Past Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

3303 S Bond Ave
Portland, OR 97239
Phone (503) 494-3151

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

3181 SW Sam Jackson Park Rd
#L352A
Portland, OR 97239
Phone (503) 434-6687

Interoperability endpoints

  • Direct secure messaging: bpeters123838@direct.ohsu.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1871147876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD # L352A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD # L352A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "BLAIR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-29",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MO",
            "license": "2019011349",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "OR",
            "license": "197514",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.