Individual provider Active NPI

Austin Gresham, MSTCM

  • Acupuncturist
  • Aurora, CO
National Provider Identifier
1104364819
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
17109 Issued in CA
Practice address
14400 E Jewell Ave
Aurora, CO 80012-5689
Phone
(303) 283-5476
NPI assigned
Feb 2, 2017
Last updated
Apr 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 17109 CA Primary

Addresses

Primary practice location

14400 E Jewell Ave
Aurora, CO 80012-5689

Mailing address

1890 S Dale CT
Denver, CO 80219-4919
Phone (843) 597-4950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1104364819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 S DALE CT",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802194919",
            "telephone_number": "843-597-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14400 E JEWELL AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800125689",
            "telephone_number": "303-283-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRESHAM",
        "first_name": "AUSTIN",
        "credential": "MSTCM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-02",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "17109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.