NPIMap

Individual provider Active NPI

Trevor Adrian Daniel Gorman, PA-C

  • Surgical Physician Assistant
  • Bristol, TN
National Provider Identifier
1306175997
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5712 Issued in TN
Practice address
1 Medical Park Blvd Ste 400E
Bristol, TN 37620-7431
Phone
(423) 844-5400
NPI assigned
Dec 10, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5712 TN
Medical Physician Assistant 363AM0700X 5712 TN
Surgical Physician Assistant 363AS0400X 5712 TN Primary

Addresses

Primary practice location

1 Medical Park Blvd Ste 400E
Bristol, TN 37620-7431

Mailing address

1 Medical Park Blvd Ste 400E
Bristol, TN 37620-7431
Phone (423) 844-5400

Other identifiers 1

IdentifierTypeStateIssuer
5712OtherTNSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20240308001377 TN Practitioner - Physician Assistant 2961848247 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell Clinic, PCGroup PAC ID 9638082076, 229 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Suite 300E
Bristol, TN 37620-7497
Phone (423) 434-6300

1 Medical Park Blvd
Suite 400E
Bristol, TN 37620-7431
Phone (423) 844-5400

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

3 Professional Park Dr
Johnson City, TN 37604-6529
Phone (423) 434-6300

Hospital & facility affiliations

  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5712TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Clinic PC CurrentSince Jun 1, 2025 Accepting new patients
Titan Orthopedics of Memphis, PLLC CurrentSince Jun 1, 2025 Accepting new patients
Campbell Clinic Past Accepting new patients

Locations

1 Medical Park Blvd
Ste 400E
Bristol, TN 37620
Phone (423) 844-5400

1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14704/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4
  • Direct secure messaging: trevor.gorman.1@1366.direct.athenahealth.com

Organizations & group practices 27

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

View all 27

Hospital & facility affiliations 1

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": "1260403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1306175997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD STE 400E",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207431",
            "telephone_number": "423-844-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD STE 400E",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207431",
            "telephone_number": "423-844-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "TREVOR",
        "middle_name": "ADRIAN DANIEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-10",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "5712",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "5712",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "5712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5712",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.