KATLYN RENE PETERSON OD
NPI 1538768007
Optometrist in Portland, OR
About Katlyn Rene Peterson Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KATLYN RENE PETERSON OD (NPI 1538768007) is an individual optometrist in Portland, Oregon, licensed in Oregon (ATI4633) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS and is a graduate of University Of Missouri St Louis - School Of Optometry (2020).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Katlyn Rene Peterson Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Katlyn Peterson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Portland, OR 97205
- Reassigned Medicare billing, Oregon enrollment
- 2 clinicians in this Medicare group
Portland, OR 97211
- Reassigned Medicare billing, Oregon enrollment
- 8 clinicians in this Medicare group
Milwaukie, OR 97222
- Reassigned Medicare billing, Oregon enrollment
- 85 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 2
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 97205 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Katlyn Peterson's NPI number?
The NPI number for Katlyn Peterson is 1538768007. It was assigned to this individual provider in the NPPES registry on October 25, 2020.
Where is Katlyn Peterson located?
Katlyn Peterson practices at 921 SW 16th Ave, Portland, OR 97205. The listed phone number is (503) 227-0573.
What is Katlyn Peterson's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Katlyn Peterson enrolled in Medicare?
Yes. Katlyn Peterson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Katlyn Peterson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Katlyn Peterson reassigns Medicare benefits to 3 organizations: Urban Eye Gallery, LLC (Portland, OR), Alberta Eye Care (Portland, OR) and Eye Health Northwest, PC (Milwaukie, OR). Each 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 Katlyn Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Katlyn Peterson accept?
Health plans from Anthem Blue Cross and Blue Shield, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan list Katlyn Peterson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Katlyn Peterson was last updated on August 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 57 days 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.
# Katlyn Rene Peterson, OD · NPI 1538768007
Optometrist provider in Portland, Oregon. Individual provider, active in the CMS NPPES registry since October 25, 2020.
## Identity
- **NPI:** 1538768007 (Entity type: Individual)
- **Enumerated:** October 25, 2020
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** ATI4633 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 921 SW 16TH AVE, Portland, OR 97205-1730
- **Phone:** (503) 227-0573 · **Fax:** (503) 227-0509
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Urban Eye Gallery, LLC (NPI 1124466545, Portland, OR); Alberta Eye Care (NPI 1740538388, Portland, OR); Eye Health Northwest, PC (NPI 1619959731, Milwaukie, OR) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Missouri St Louis - School Of Optometry, class of 2020
## Record status
- **NPPES last updated:** August 27, 2026
- **Other identifiers:** Medicaid 500807355 (OR)
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Source: [NPI Profile](https://npiprofile.com/npi/1538768007) · Data from the CMS NPPES public registry.