Sally Rothacker Peyton, APRNCS, PMH-NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R042060 Issued in ME

Practice address

619 NW 6TH Ave FL 3
Portland, OR 97209-3964

Phone

(503) 988-3663

Fax

(503) 988-4098

NPI assigned

Dec 14, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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 1336287416
  NPD (past)

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1952386732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 NW 6TH AVE FL 5",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 NW 6TH AVE FL 3",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093964",
            "telephone_number": "503-988-3663",
            "fax_number": "503-988-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHACKER PEYTON",
        "first_name": "SALLY",
        "credential": "APRNCS, PMH-NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "R042060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123350000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maggie Alicea Roth
• Meryl Roth
• Natasha Roth
• Richard Walter Roth, OD
• Zara Roth
• Daniel Keith Rothenberg
• Kristi E Rothenbucher, M.A., CADC I
• Anna Rothgeb
• Ilan Jose Rothman, MD
• Sarah Rose Rothman

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.