Gresham Internal Medicine Clinic
Gresham Internal Medicine Clinic is a healthcare organization registered as Internal Medicine Physician in Gresham, OR, holding Type 2 (organization) NPI 1134204340 since 2006. The authorized official on file is John Custis, Owner/Partner.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1134204340 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Gresham Internal Medicine Clinic |
| Practice address | 24900 SE STARK ST STE 109, Gresham, OR, 97030 |
| Phone | 5036671015 |
| Fax | 5036670406 |
| Enumeration date | 2006-10-26 |
| Last updated in NPPES | 2008-12-11 |
Authorized official
| Name | John Custis |
|---|---|
| Title | Owner/Partner |
| Phone | 5036671015 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 207R00000X | Internal Medicine Physician | Primary | 01794 | OR |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CS0995 | Other | OR | RAILROAD MEDICARE |
Copy-ready billing details
Provider: Gresham Internal Medicine Clinic NPI: 1134204340 Taxonomy: 207R00000X (Internal Medicine Physician) Address: 24900 SE STARK ST STE 109, Gresham, OR, 97030
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1568464261 | Bradley Evans | Individual | Cardiovascular Disease Physician | Gresham, OR |
| 1780806125 | Laura Flath | Individual | Internal Medicine Physician | Gresham, OR |
| 1801150214 | Avnish Tripathi | Individual | Interventional Cardiology Physician | Gresham, OR |
| 1417360587 | Edward Cheng | Individual | Clinical Cardiac Electrophysiology Physician | Gresham, OR |
| 1265897599 | David Strickland | Individual | Medical Physician Assistant | Gresham, OR |
| 1194451971 | Samuel Frazier | Individual | Clinical Nurse Specialist | Gresham, OR |
Verify this record
Cross-check NPI 1134204340 against the authoritative CMS record: view Gresham Internal Medicine Clinic on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Gresham Internal Medicine Clinic?
Source: CMS NPPES (public data). Snapshot 2026-07-10. Provider record last updated 2008-12-11.