DR. PETER JACK TAYLOR (D.O.) – Psychiatry Physician, NPI 1124207436

DR. PETER JACK TAYLOR (D.O.) is a healthcare provider. based in Portland, Oregon. specializing in PSYCHIATRY. They hold the professional credentials D.O.. They hold a License No. 005971 (AZ). The NPI Number for DR. PETER JACK TAYLOR (D.O.) is 1124207436

Main info

Male
20 Years Of Experience
Accepts Medicare Assignment
Name
DR. PETER JACK TAYLOR (D.O.)
NPI
1124207436
Phone
Not provided
Address
PO BOX 3158
Enumeration Date
2 November 2007
Last Update Date
6 October 2020

Doctor Profile

Medical School Name
MID WEST MEDICAL COLLEGE
Secondary Phone
5032156405
Graduation Year
2006 (20 years ago)
PAC ID
5092989103
Group Practice PAC ID
0648183608
Professional Enrollment ID
I20111129000244
Address ID
OR972132984PO5050XSTXX407
Telehealth
Yes

Contacts

Secure Messaging
ptaylor791191@oc.providencedirect.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience69
Completeness85
Years active:18State licenses:2Other namesUpdated within 12 months

455 PSYCHIATRY in OR

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Provider Addresses for DR. PETER JACK TAYLOR (D.O.)

  • 3158, Southwest 87th Avenue, Portland, Metro, Washington County, Oregon, 97225, United States

    PORTLAND, OR 972083158

    Phone:

    Type: Mailing

  • Southeast 32nd Avenue, Ardenwald-Johnson Creek, Milwaukie, Metro, Clackamas County, Oregon, 97222, United States

    MILWAUKIE, OR 972223625

    Phone: (503) 513-1410

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-11-29

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20111129000244IPsychiatryORTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes384124$0
90847Family psychotherapy with patient, 50 minutes335120$0
90833Psychotherapy with evaluation and management visit, 30 minutes12363$0
99204New patient office or other outpatient visit, 45-59 minutes8787$0
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes7927$0
View full utilization report →

Insurance plans in this area (ZIP 97208)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0648183608View full group profile
NameSpecialtyState
Internal MedicineOR
Physician AssistantOR
-OR
N E U R O L O G YOR
Nurse PractitionerOR
Infectious Disease, Internal MedicineOR
Thoracic SurgeryOR
Nurse PractitionerOR
Physician AssistantWA
Clinical PsychologistOR

Reviews

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Frequently asked questions

How is DR. PETER JACK TAYLOR (D.O.) identified in CMS data?
CMS-hosted NPPES data lists DR. PETER JACK TAYLOR (D.O.) with NPI 1124207436.
Can I rely on DR. PETER JACK TAYLOR (D.O.) being an active provider?
As of the registry snapshot, DR. PETER JACK TAYLOR (D.O.) is marked active.
What is DR. PETER JACK TAYLOR (D.O.)'s specialty?
The listing groups DR. PETER JACK TAYLOR (D.O.) with Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Does DR. PETER JACK TAYLOR (D.O.) list a practice location?
Patients near Portland, Oregon may find DR. PETER JACK TAYLOR (D.O.) in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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