NPIMap

Individual provider Active NPI

Richard Wayne Craft Sr., MD

  • Internal Medicine Physician
  • Gresham, OR
National Provider Identifier
1104844661
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD16231 Issued in OR
Practice address
24900 SE Stark St Ste 202
Gresham, OR 97030-3382
Phone
(503) 465-8887
Fax
(503) 465-8808
NPI assigned
Jul 17, 2006
Last updated
Feb 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD16231 OR Primary

Addresses

Primary practice location

24900 SE Stark St Ste 202
Gresham, OR 97030-3382

Mailing address

24900 SE Stark St
Ste 202
Gresham, OR 97030
Phone (503) 465-8887

Other identifiers 1

IdentifierTypeStateIssuer
044453MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041007000234 OR Practitioner - Internal Medicine 6507825379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oregon Health Sciences University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

24900 SE Stark St
Suite 202
Gresham, OR 97030-3382
Phone (360) 882-2778

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions33
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
16231ORMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Feb 1, 2023 Accepting new patients
The Vancouver Clinic Inc PS Internal Medicine CurrentSince Feb 1, 2023 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

24900 SE Stark St
Ste 202
Gresham, OR 97030
Phone (503) 465-8887

340 NW Burnside Rd
Gresham, OR 97030
Phone (971) 432-7500

2222 NW Lovejoy St
Ste 505
Portland, OR 97210
Phone (503) 226-4091

19250 SW 65th Ave
Ste 110
Tualatin, OR 97062
Phone (503) 692-1205

Interoperability endpoints

  • Direct secure messaging: rcraft21292@tvc-direct.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1104844661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24900 SE STARK ST",
            "address_2": "STE 202",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "503-465-8887",
            "fax_number": "503-465-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24900 SE STARK ST STE 202",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303382",
            "telephone_number": "503-465-8887",
            "fax_number": "503-465-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAFT",
        "first_name": "RICHARD",
        "middle_name": "WAYNE",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD16231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044453",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

Verify at the official NPI Registry.