Michael J Gibson, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

199 Issued in OK

Practice address

100 McDougal Dr
Holdenville, OK 74848-2822

Phone

(405) 379-4202

Fax

(405) 379-4340

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Holdenville Hospital Authority

  • Critical Access Hospital
  • Holdenville, OK
  • NPI 1265851455
  Medicare reassignment NPD
• Holdenville Hospital Authority

  • Rural Health Clinic/Center
  • Wewoka, OK
  • NPI 1285038596
  NPD
• R E F M Emergency Services

  • Emergency Care Clinic/Center
  • Hugo, OK
  • NPI 1194716530
  NPD (past)
• Comprehensive Emergency Solutions SC

  • Emergency Medicine Physician
  • Peoria, IL
  • NPI 1477515393
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1487681201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MCDOUGAL DR",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748482822",
            "telephone_number": "405-379-4202",
            "fax_number": "405-379-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MCDOUGAL DR",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748482822",
            "telephone_number": "405-379-4202",
            "fax_number": "405-379-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC REGION C",
            "identifier": "0784740001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100848080A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MC",
            "identifier": "P00266954",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Embrace Hope Counseling. LLC
• Kenya Fields
• Terri L Ford
• Willard Bill Freeman, D.C.
• Jennifer Michele Gaines
• GLN of Holdenville, Inc
• Helen Celeste Gordon, R.N.
• Alicia Rose Gosey, APRN-CNP
• Itha Joyce Gray, ICADC
• Katherine Denise Lynn Green, APRN

• Medical Physician Assistant in Holdenville, OK
• Providers in Holdenville, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.