Derrick Durell Wagoner, D.O.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

6324 Issued in OK

Practice address

1800 Renaissance Blvd Ste 110
Edmond, OK 73013

Phone

(405) 601-2325

NPI assigned

May 23, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Pain Management

Education

West Virginia School of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gershon Pain Specialists LLCGroup PAC ID 7618075821, 7 clinicians

Associated Radiologists of the Finger Lakes PCGroup PAC ID 5294623955, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arnot Ogden Medical Center Hospital, Elmira, NY, CCN 330090
• Ira Davenport Memorial Hospital Hospital, Bath, NY, CCN 330800
• Corning Hospital Hospital, Corning, NY, CCN 330277

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

84.55 of 100Reported as group

Quality

71.62

Promoting interoperability

100

Improvement activities

40

Cost

76.89

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwagoner27707@direct.xtensys.com
• FHIR API: https://api.platform.athenahealth.com/1684/brand/1/csg/1/fhir/r4
• Direct secure messaging: derrick.wagoner.1@1684.direct.athenahealth.com

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.

• Associated Radiologists of the Finger Lakes PC

  • Diagnostic Ultrasound Physician
  • Elmira, NY
  • NPI 1063489060

  Diagnostic Radiology, VA

  Medicare reassignment Care Compare group NPD
• Gershon Pain Specialists, LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Virginia Beach, VA
  • NPI 1871710798
  Medicare reassignment Care Compare group NPD
• Gershon Pain Specialists, LLC

  • Durable Medical Equipment & Medical Supplies
  • Virginia Beach, VA
  • NPI 1760755847
  NPD
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

• Arnot Ogden Medical Center

  • General Acute Care Hospital
  • Elmira, NY
  • NPI 1083605661
  Care Compare affiliation
• Corning Hospital

  • General Acute Care Hospital
  • Corning, NY
  • NPI 1346241973
  Care Compare affiliation
• Ira Davenport Memorial Hospital, Inc.

  • Rural Acute Care Hospital
  • Bath, NY
  • NPI 1306930318
  Care Compare affiliation

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

{
    "created_epoch": "1369267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1760829220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 SHAPPEE ST",
            "city": "HORSEHEADS",
            "state": "NY",
            "postal_code": "148451918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 RENAISSANCE BLVD STE 110",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73013",
            "telephone_number": "405-601-2325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 Essjay Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142218243",
            "country_code": "US",
            "telephone_number": "716-630-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "DERRICK",
        "middle_name": "DURELL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-23",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "6324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200769850A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole R Wade, PTA
• Jordyn Nicole Wadley
• Emmanuel Wadmia
• Benjamin Wagner
• Cynthia Ann Wagner, R.M.T.
• Elizabeth Wagoner, DPH
• Wal-Mart Stores East , LP (Walmart Vision Center 30-2803)
• Wal-Mart Stores East , LP (Walmart Pharmacy 10-0389)
• Wal-Mart Stores East , LP (Walmart Vision Center 30-0389)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2803)

• Diagnostic Radiology Physician in Edmond, OK
• Providers in Edmond, OK by specialty
• Diagnostic Radiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.