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

Q: 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.

Q: What is Amy Peck's specialty?

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

Q: 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 6 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.

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: August 02, 2026.

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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

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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)