DR. JED RUSSELL PETERSON (M.D.) – Vascular & Interventional Radiology Physician, NPI 1164634770

DR. JED RUSSELL PETERSON (M.D.) is a healthcare provider. based in Portland, Oregon. specializing in INTERVENTIONAL RADIOLOGY, DIAGNOSTIC RADIOLOGY. They hold the professional credentials M.D.. They hold a License No. MD.60212410 (WA). The NPI Number for DR. JED RUSSELL PETERSON (M.D.) is 1164634770

Main info

Male
Sole Proprietor
20 Years Of Experience
Accepts Medicare Assignment
Name
DR. JED RUSSELL PETERSON (M.D.)
NPI
1164634770
Phone
(503) 251-6137
Address
10123 SE MARKET ST
Enumeration Date
4 May 2007
Last Update Date
15 October 2012

Doctor Profile

Medical School Name
ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
Secondary Phone
5032516855
Graduation Year
2006 (20 years ago)
PAC ID
7012172166
Group Practice PAC ID
4183510902
Professional Enrollment ID
I20120622000541
Address ID
OR970899317DA21835STXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience66
Completeness75
Years active:19State licenses:2Digital endpointsOther names

85 INTERVENTIONAL RADIOLOGY in OR

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Provider Addresses for DR. JED RUSSELL PETERSON (M.D.)

  • Adventist Medical Center, 10123, Southeast Market Street, Hazelwood, Portland, Metro, Multnomah County, Oregon, 97216, United States

    DEPARTMENT OF RADIOLOGY

    PORTLAND, OR 972162532

    Phone: (503) 251-6137

    Fax: (503) 261-6058

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 106 Open Payments records for all available years, with a total value of $5,643.

Total Amount is formed as General ($5,643) + Research ($0) + Ownership ($0) = $5,643.

Last reported payment date: 2024-12-20 • Largest payer in this snapshot: Inari Medical, Inc. ($1,539).

Total Amount

$5,643

General + Research + Ownership

Payments

106

Total payment records

General Amount

$5,643

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-20

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2012-06-22

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
I20120622000541IDiagnostic RadiologyORTBD

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
71045X-ray of chest, 1 view177156$0
71046X-ray of chest, 2 views8180$0
99152Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes4746$0
73502X-ray of hip, 2-3 views4542$0
73564X-ray of knee, 4 or more views4224$0
View full utilization report →

Insurance plans in this area (ZIP 97216)

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Provider's Procedures

DR. JED RUSSELL PETERSON (M.D.) performs procedures in INTERVENTIONAL RADIOLOGY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYOR71010X-ray of chest, 1 view, front260212
DIAGNOSTIC RADIOLOGYOR73562X-ray of knee, 3 views1815
DIAGNOSTIC RADIOLOGYOR76830Ultrasound pelvis through vagina1313
DIAGNOSTIC RADIOLOGYOR78815Nuclear medicine study with CT imaging skull base to mid-thigh1212

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: 4183510902View full group profile
NameSpecialtyState
-OR
-OR
Interventional Radiology, Diagnostic RadiologyOR
Diagnostic RadiologyCA
Diagnostic RadiologyVA
Interventional Radiology, Diagnostic Radiology, Diagnostic Radiology, Interventional RadiologyOR
Diagnostic RadiologyCT
Diagnostic RadiologyOR
Diagnostic RadiologyOR
Diagnostic RadiologyMO

Reviews

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Frequently asked questions

What is DR. JED RUSSELL PETERSON (M.D.)'s NPI number?
DR. JED RUSSELL PETERSON (M.D.)'s NPI is 1164634770 — the number used across U.S. healthcare to identify this provider.
Would DR. JED RUSSELL PETERSON (M.D.) appear as active to a payer?
You can treat DR. JED RUSSELL PETERSON (M.D.) as active for directory purposes; confirm clinical privileges separately.
How would a patient describe DR. JED RUSSELL PETERSON (M.D.)'s focus?
For DR. JED RUSSELL PETERSON (M.D.), the primary taxonomy reads as Vascular & Interventional Radiology Physician. Clinical services aligned with this taxonomy classification.
Is DR. JED RUSSELL PETERSON (M.D.) associated with Portland?
Public fields place DR. JED RUSSELL PETERSON (M.D.) around Portland, Oregon. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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