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AMY SAMANTHA PECK
NPI 1174170682
Nurse Practitioner - Primary Care in Portland, OR

Active since August 20, 2019PECOS Enrolled
12710 SE DIVISION ST, PORTLAND, OR 97236(503) 988-3601 Get Directions Write a Review

NPPES record last updated: August 20, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Amy Samantha Peck NPPES

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

AMY SAMANTHA PECK (NPI 1174170682) is an individual primary care provider in Portland, Oregon, licensed in Oregon (201907329NP-PP) and active in the NPI registry since August 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174170682
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameAMY SAMANTHA PECK
Location Address12710 SE DIVISION STPortland, OR 97236-3134
Mailing Address4222 Ne Cleveland AvePortland, OR 97211-2704 · (503) 866-2746
Phone(503) 988-3601
Sole ProprietorNo
Enumeration DateAugust 20, 2019
✔ NPI 1174170682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in OR · 201907329NP-PP
12710 SE DIVISION ST, Portland, OR 97236
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amy Samantha Peck 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 Reassignment

Medicare enrollment records show Amy Peck reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Multnomah County
Same address
Federally Qualified Health Center (FQHC)
12710 SE DIVISION ST
Portland, OR 97236
  • Reassigned Medicare billing, Oregon enrollment
  • 215 clinicians in this Medicare group
NPI 1245378322 (503) 988-3663

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97236 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
$90.51 typical visit price
range $58.99 – $176.88
Typical copayment $22.62 (range $14.74 – $44.22)
Most-billed visit code 99203
Established Patient
$103.51 typical visit price
range $19.32 – $144.79
Typical copayment $25.87 (range $4.83 – $36.19)
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.

DR. SERGEY Y KIRPICHENKO DMD
Dentist (General Practice)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410
DR. SAMY F TANYOS D.M.D.
Dentist
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3816
DONALD EUGENE POSTEN LCSW
Social Worker (Clinical)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3601
DR. ALYSSA T FRANZEN DMD
Dentist (General Practice)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410
DERRICK MICHAEL JONES PA-C
Physician Assistant (Medical)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3601
WHITNEY THOMAS
Nurse Practitioner (Family)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-5558
DR. MASTANEH POURNADERI D.D.S
Dentist
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410
MULTNOMAH COUNTY
Clinic/Center (Federally Qualified Health Center (FQHC))
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410

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 Amy Peck's NPI number?

The NPI number for Amy Peck is 1174170682. It was assigned to this individual provider in the NPPES registry on August 20, 2019.

Where is Amy Peck located?

Amy Peck practices at 12710 SE Division St, Portland, OR 97236. The listed phone number is (503) 988-3601.

What is Amy Peck's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Amy Peck enrolled in Medicare?

Yes. Amy Peck is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Amy Peck's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Amy Peck reassigns Medicare benefits to Multnomah County (Portland, OR). The 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 Amy Peck's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Amy Peck was last updated on August 20, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.