DR. MICHAEL DOUGLAS GORMAN (MD) – Family Medicine Physician, NPI 1639332042

DR. MICHAEL DOUGLAS GORMAN (MD) is a healthcare provider. based in Wagoner, Oklahoma. specializing in FAMILY PRACTICE. They hold the professional credentials MD. They hold a License No. 28153 (OK). The NPI Number for DR. MICHAEL DOUGLAS GORMAN (MD) is 1639332042

Main info

Male
18 Years Of Experience
Accepts Medicare Assignment
Name
DR. MICHAEL DOUGLAS GORMAN (MD)
NPI
1639332042
Phone
(918) 485-5591
Address
410 E CHEROKEE ST
Enumeration Date
7 July 2008
Last Update Date
8 March 2016

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9188577246
Graduation Year
2008 (18 years ago)
PAC ID
4789858960
Group Practice PAC ID
8628390515
Professional Enrollment ID
I20111128000628
Address ID
OK741463629TU4110XAVEX501
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness75
Years active:17State licenses:2Digital endpointsOther names

1,775 FAMILY PRACTICE in OK

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Provider Addresses for DR. MICHAEL DOUGLAS GORMAN (MD)

  • 410, East Cherokee Street, Wagoner, Wagoner County, Oklahoma, 74467, United States

    WAGONER, OK 744674708

    Phone: (918) 485-5591

    Fax: (918) 485-5758

    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 1 Open Payments records for all available years, with a total value of $89.

Total Amount is formed as General ($89) + Research ($0) + Ownership ($0) = $89.

Last reported payment date: 2023-11-16 • Largest payer in this snapshot: Pharmacosmos Therapeutics Inc. ($89).

Total Amount

$89

General + Research + Ownership

Payments

1

Total payment records

General Amount

$89

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-16

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: 2011-11-28

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
I20111128000628IFamily PracticeOKTBD

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 74467)

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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: 8628390515View full group profile
NameSpecialtyState
Family PracticeOK
Family PracticeOK
Nurse PractitionerOK
Nurse PractitionerOK
Nurse PractitionerOK
Interventional Radiology, Diagnostic RadiologyOK
Nurse PractitionerOK
-OK
Nurse PractitionerOK

Reviews

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Frequently asked questions

How do I look up DR. MICHAEL DOUGLAS GORMAN (MD) by NPI?
Use NPI 1639332042 when you need to reference DR. MICHAEL DOUGLAS GORMAN (MD) in forms, claims, or directories.
Does this profile mean DR. MICHAEL DOUGLAS GORMAN (MD) is currently active?
Yes — DR. MICHAEL DOUGLAS GORMAN (MD) appears active in the national provider directory.
Does DR. MICHAEL DOUGLAS GORMAN (MD) list a primary specialty?
If you are matching referrals, note Family Medicine Physician for DR. MICHAEL DOUGLAS GORMAN (MD). Clinical services aligned with this taxonomy classification.
Does DR. MICHAEL DOUGLAS GORMAN (MD) practice in Oklahoma?
You will see Wagoner, Oklahoma on file for DR. MICHAEL DOUGLAS GORMAN (MD) alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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