Active NPI 1801150214 Individual Practitioner Male Practitioner

Dr. Avnish Tripathi , MD, PhD, MPH

Internal Medicine - Interventional Cardiology • Gresham, OR

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Dr. Avnish Tripathi, MD, PhD, MPH is a certified Internal Medicine - Interventional Cardiology practicing in Gresham, OR. With approximately 23 years of clinical experience since completing medical education in 2003, Dr. Tripathi delivers high-quality medical care to the local community at 24900 SE STARK ST STE 109.

Dr. Tripathi maintains professional affiliations with Legacy Good Samaritan Hospital And Medical Center, Legacy Mount Hood Medical Center, Legacy Clinics Llc and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include established patient outpatient office visit, moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first, routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

24900 Se Stark St Ste 109

Gresham, OR 970303381

Telephone 5036744100

Associated Practice Facility / Clinic

🏢 Gresham Internal Medicine Clinic Facility NPI 1134204340

Medicare Profile & Education

Medical School

Other

Graduation Year

2003

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine - Interventional Cardiology in Gresham, OR

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

23 Yrs Matches City Avg

City Avg: 23.0 Yrs

State Avg: 22.3 Yrs

Regional Practice Density

1 Specialists

Practicing in Gresham, OR (70 Statewide)

Telehealth Adoption Rate

100.0% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

65.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Tripathi (23 Years) 23 Yrs

Gresham Specialty Average (23.0 Years) 23.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	62	55	$189.40	$104.80
99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes	35	34	$128.26	$11.77
93010 Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only	25	25	$18.00	$7.47
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	25	25	$417.20	$65.02
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	24	18	$44.00	$15.49
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	21	14	$134.19	$74.41
93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist	18	18	$938.78	$251.74
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	18	12	$317.00	$120.84
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	17	15	$462.00	$176.51
92978 Ultrasound evaluation of heart blood vessel or graft	16	15	$247.00	$92.21
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	14	14	$587.00	$230.47
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	13	13	$230.08	$122.79
92928 Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch	13	11	$1544.00	$548.15

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	243	128	$101.46	$89.83
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	179	90	$97.00	$72.59
93010 Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only	124	104	$18.00	$7.55
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	90	87	$134.44	$63.14
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	81	81	$195.00	$119.61
99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes	56	47	$123.79	$11.27
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	45	44	$133.33	$63.96
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	34	34	$48.00	$19.74
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	33	33	$46.00	$13.02
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	30	30	$157.93	$122.21
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	30	30	$200.00	$71.05
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	29	23	$138.00	$131.84
93925 Ultrasound of leg arteries or artery grafts	26	26	$58.00	$34.51
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	26	26	$45.00	$19.64
93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist	25	24	$601.00	$211.81
93880 Ultrasound of both sides of head and neck blood flow	23	23	$60.00	$35.22
93922 Ultrasound study of arm and leg arteries	20	20	$25.00	$11.01
75625 Radiological supervision and interpretation X-ray of abdominal aorta	17	15	$157.53	$61.09
99213 Established patient office or other outpatient visit, typically 15 minutes	17	16	$68.00	$60.80
36247 Insertion of tube into abdominal, pelvic, or leg artery, initial third order branch	13	12	$463.85	$287.77

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	278	193	$177.03	$108.42
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	156	153	$138.76	$65.68
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	91	51	$176.86	$95.73
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	90	49	$97.00	$65.36
99213 Established patient office or other outpatient visit, typically 15 minutes	76	68	$149.60	$81.95
J2785 Injection, regadenoson, 0.1 mg	64	16	$700.00	$61.17
93010 Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only	55	54	$18.25	$7.70
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	54	53	$222.38	$140.11
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	53	53	$278.52	$128.00
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	51	50	$346.20	$185.38
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	49	47	$195.86	$121.96
93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist	42	40	$577.61	$233.59
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	40	40	$481.86	$224.07
99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes	37	31	$82.00	$11.45
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose	36	18	$3750.00	$1246.11
93970 Ultrasound study of arm or leg veins with compression and maneuvers	32	32	$211.96	$90.49
76937 Ultrasonic guidance for blood vessel access	31	24	$31.00	$12.84
99225 Subsequent observation care, typically 25 minutes per day	24	17	$125.42	$67.43
93793 Anticoagulant management of patient taking warfarin	23	12	$20.30	$10.71
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	22	22	$46.00	$13.55
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	22	22	$48.00	$20.25
93015 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician	18	18	$125.29	$58.21
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	18	17	$138.00	$134.43
93325 Doppler ultrasound study of color-directed heart blood flow, rate, and valve function	16	16	$5.83	$3.00
93880 Ultrasound of both sides of head and neck blood flow	15	15	$60.00	$33.60
93312 Ultrasound of heart with probe in esophagus, with report	15	15	$193.97	$103.99
93320 Ultrasound of heart blood flow, valves and chambers	15	15	$32.29	$17.23
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	14	14	$218.00	$90.93
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	14	14	$45.00	$20.01
92978 Ultrasound evaluation of heart blood vessel or graft	13	12	$203.45	$87.62
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	11	11	$242.73	$157.98
93925 Ultrasound of leg arteries or artery grafts	11	11	$58.00	$35.56

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	489	240	$228.64	$120.74
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	251	120	$178.70	$98.69
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	186	181	$124.32	$68.15
J2785 Injection, regadenoson, 0.1 mg	184	45	$700.00	$57.45
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose	138	68	$3722.83	$1197.75
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	103	103	$307.86	$157.97
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	93	90	$348.69	$191.28
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	79	77	$355.78	$174.03
93793 Anticoagulant management of patient taking warfarin	75	30	$20.71	$10.81
93015 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician	73	72	$153.95	$57.10
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	69	68	$831.52	$414.99
99213 Established patient office or other outpatient visit, typically 15 minutes	55	44	$159.20	$86.15
93970 Ultrasound study of arm or leg veins with compression and maneuvers	47	47	$335.54	$154.08
99225 Subsequent observation care, typically 25 minutes per day	46	36	$125.42	$67.78
93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist	43	42	$568.11	$228.06
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	36	36	$35.76	$14.09
93925 Ultrasound of leg arteries or artery grafts	36	35	$436.98	$211.97
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	35	35	$38.38	$21.13
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	34	34	$137.72	$74.95
93924 Ultrasound study of arteries of both legs at rest and exercise	33	33	$282.44	$116.87
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	31	31	$325.40	$138.90
75630 Review by radiologist of abdominal aorta and both leg arteries image	17	14	$169.10	$93.13
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	15	12	$184.28	$81.40
93312 Ultrasound of heart with probe in esophagus, with report	14	13	$191.68	$105.29
93325 Doppler ultrasound study of color-directed heart blood flow, rate, and valve function	14	13	$5.52	$3.05
36475 Destruction of insufficient vein of arm or leg, accessed through the skin	13	11	$2220.96	$1167.58
93320 Ultrasound of heart blood flow, valves and chambers	12	11	$31.74	$17.49
36245 Insertion of tube into abdominal, pelvic, or leg artery, each first order branch	12	12	$2702.78	$341.31

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	286	154	$208.88	$102.17
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	233	94	$201.02	$101.30
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	154	148	$196.68	$71.99
93793 Anticoagulant management of patient taking warfarin	138	37	$50.96	$10.93
J2785 Injection, regadenoson, 0.1 mg	136	34	$368.75	$57.96
99213 Established patient office or other outpatient visit, typically 15 minutes	107	78	$140.58	$69.99
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose	96	48	$1972.66	$1240.92
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	94	89	$390.10	$196.56
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	88	88	$380.94	$152.88
93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist	61	58	$2402.35	$243.91
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	61	57	$524.48	$172.25
93015 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician	50	50	$194.26	$57.15
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	48	48	$1182.09	$421.28
99225 Subsequent observation care, typically 25 minutes per day	36	28	$140.12	$70.63
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	33	32	$211.84	$77.53
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	32	31	$59.51	$21.78
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	32	31	$39.69	$14.53
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	31	16	$139.50	$69.77
99443 Telephone medical discussion with physician, 21-30 minutes	22	20	$128.98	$96.42
92928 Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch	22	16	$1595.28	$483.38
93228 Electrocardiogram (ecg) up to 30 days continuous with review and report by health care professional	21	20	$71.39	$26.24
93000 Routine ekg using at least 12 leads including interpretation and report	20	20	$43.40	$15.82
93925 Ultrasound of leg arteries or artery grafts	20	18	$630.30	$219.05
99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes	19	17	$126.70	$11.57
36245 Insertion of tube into abdominal, pelvic, or leg artery, each first order branch	19	15	$6350.99	$224.41
93970 Ultrasound study of arm or leg veins with compression and maneuvers	18	17	$485.27	$164.93
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	15	13	$37.56	$21.07
75630 Review by radiologist of abdominal aorta and both leg arteries image	15	12	$261.34	$92.71
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	14	14	$469.73	$137.97
92978 Ultrasound evaluation of heart blood vessel or graft	11	11	$255.89	$93.88

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	98	68	$272.89	$101.46
J2785 Injection, regadenoson, 0.1 mg	88	21	$120.00	$58.30
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose	54	26	$1875.00	$1254.60
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	46	36	$50.96	$20.72
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	45	43	$148.19	$71.18
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	44	24	$187.96	$69.68
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	43	43	$574.35	$154.59
99213 Established patient office or other outpatient visit, typically 15 minutes	32	25	$185.32	$67.93
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	31	30	$486.42	$166.74
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	29	14	$269.96	$99.64
93015 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician	27	26	$199.41	$58.35
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	26	25	$1050.28	$431.05
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	22	21	$294.90	$193.76
93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist	20	19	$2718.18	$211.23
93000 Routine ekg using at least 12 leads including interpretation and report	17	17	$26.31	$15.67
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	16	16	$37.73	$14.37
93793 Anticoagulant management of patient taking warfarin	15	14	$50.96	$11.36
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	15	15	$94.39	$21.53
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	15	15	$185.46	$76.66
92928 Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch	11	11	$1565.45	$552.87

Medical Specialties & State Licenses

CMS Verified: 2025-06-09

Internal Medicine - Interventional Cardiology Primary Specialty

NUCC Taxonomy Code: 207RI0011X

State License WA 61496230

An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License OR MD218304

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Internal Medicine - Interventional Cardiology

NUCC Taxonomy Code: 207RI0011X

State License AR E-15427

Hospital & Practice Group Affiliations

Legacy Salmon Creek Hospital

2121 Ne 139th St, Vancouver, WA 986862316

Legacy Clinics Llc

501 N Graham St, Portland, OR 972272000

Phone: 5034134488

Legacy Mount Hood Medical Center

24800 Se Stark St, Gresham, OR 970303378

Phone: 5036619150

Legacy Salmon Creek Hospital

2211 Ne 139th St, Vancouver, WA 986862742

Phone: 3604871000

Legacy Good Samaritan Hospital And Medical Center

1015 Nw 22nd Ave, Portland, OR 972103025

Phone: 5034137711

Legacy Good Samaritan Hospital And Medical Center

1200 Nw 23rd Ave, Portland, OR 972102906

Phone: 5034137074

Secondary Practice Locations

501 N Graham St Ste 200

Portland, OR 972272000

Phone: 1503413716

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners

Samuel Frazier , APRN, CNS

Clinical Nurse Specialist

NPI 1194451971

Advanced Practice Registered Nurse, Clinical Nurse Specialist

David Strickland , PA-C

Physician Assistant - Medical

NPI 1265897599

Physician Assistant (Certified)

Dr. Edward Cheng , MD

Internal Medicine - Clinical Cardiac Electrophysiology

NPI 1417360587

Doctor of Medicine (M.D.)

Dr. Bradley Evans , MD

Internal Medicine - Cardiovascular Disease

NPI 1568464261

Doctor of Medicine (M.D.)

Dr. Laura Flath , MD

Internal Medicine

NPI 1780806125

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

19 Historical Events

📍

Updated Practice Location June 09, 2025

Registered at 24900 SE STARK ST STE 109, GRESHAM, OR 970303381 (Tel: 5036744100)

📍

Updated Business Mailing Address June 09, 2025

Registered at 24900 SE STARK ST STE 109, GRESHAM, OR 970303381 (Tel: 5036744100)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 09, 2025

Internal Medicine (License #MD218304 in OR)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 21, 2022

Internal Medicine (License #E-15427 in AR)

📍

Updated Practice Location June 02, 2022

Registered at 711 SANTA FE DR, SEARCY, AR 721436964 (Tel: 5012799393)

📍

Updated Business Mailing Address June 02, 2022

Registered at 711 SANTA FE DR, SEARCY, AR 721436964 (Tel: 5012799073)

📍

Updated Practice Location June 26, 2018

Registered at 55 FRUIT ST, BOSTON, MA 02114 (Tel: 8666448910)

👤

Provider Name / Credentials Updated June 26, 2018

Recorded as AVNISH TRIPATHI, M.D., PH.D., M.P.H.

✅

NPI Profile Active May 18, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location May 18, 2017

Registered at 323 E CHESTNUT ST, LOUISVILLE, KY 402021823 (Tel: 5028521845)

📍

Updated Business Mailing Address May 18, 2017

Registered at 323 E CHESTNUT ST DEPT OF, LOUISVILLE, KY 402021823 (Tel: (502) 852-5241)

👤

Provider Name / Credentials Updated May 18, 2017

Recorded as AVNISH TRIPATHI, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 18, 2017

Internal Medicine (License #48045 in KY)

✅

NPI Profile Active June 29, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location June 29, 2012

Registered at 2500 N STATE ST, DEPARTMENT OF MEDICINE, JACKSON, MS 392164500 (Tel: 6019845601)

📍

Updated Business Mailing Address June 29, 2012

Registered at 2500 N STATE ST, DEPARTMENT OF MEDICINE, JACKSON, MS 392164500 (Tel: 6019845601)

👤

Provider Name / Credentials Updated June 29, 2012

Recorded as AVNISH TRIPATHI, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 29, 2012

Internal Medicine (License #842-L in MS)

🟢

Initial NPI Registration & Enumeration June 29, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1801150214

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 29, 2012

Last Update: June 09, 2025

Sole Proprietor: No

Update or Correct Profile

Mailing Address

24900 Se Stark St Ste 109

Gresham, OR 970303381

Phone: 5036744100

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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