NPIMap

Organization Active NPI

Goshen Medical Center, Inc

Doing business as Goshen Medical Center - Fairview

  • Federally Qualified Health Center (FQHC)
  • Clinton, NC
National Provider Identifier
1023424686
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOSHEN MEDICAL CENTER, INC
Doing business as
Goshen Medical Center - Fairview
Practice address
408 Fairview St
Clinton, NC 28328-2312
Phone
(910) 596-2400
Fax
(910) 267-8933
NPI assigned
Jul 3, 2014
Last updated
Dec 16, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GOSHEN MEDICAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Authorized official

Name
Mrs. Rebecca M Brown
Title
Credentialing
Phone
(910) 267-8252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

408 Fairview St
Clinton, NC 28328-2312

Mailing address

PO Box 187
Faison, NC 28341-0187
Phone (910) 267-0421

Other names 1

  • Goshen Medical Center - Fairview Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040102000726 NC Part B Supplier - Clinic/Group Practice 3173434479 Receives reassigned benefits from 224 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenansville, NC; Morehead City, NC; Mount Olive, NC; New Bern, NC; Rockingham, NC; Rose Hill, NC; Sanford, NC; Southport, NC…
O20140904002785 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Clinton, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023424686. Details of each certification follow.

Federally qualified health center certification: CCN 341019

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER-FAIRVIEW
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 4, 2014
Last certification
Sep 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
408 Fairview St
Clinton, NC 28328-2312

Other NPIs on the same Medicare enrollment 44

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 44

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0929678Goshen Medical Center - Fairview408 Fairview Street, Clinton, NC 28328Certificate of waiverOct 16, 2026

National Provider Directory

National Provider Directory
Part of
Goshen Medical Ctr

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rhonda Barwick Individual Operational/Managerial ControlDirector of Operations Sep 27, 2001
Chester Aycock Individual Corporate OfficerChair of the Board Feb 1, 2008
Tanty Freeman Individual Corporate Director Feb 1, 2008
Edith Anis Aizpurua de Sosa Individual Corporate DirectorBoard Member May 28, 2018
Patricia a Davis Individual Corporate OfficerSecretary Feb 1, 2008
Millie Rich Bland Individual Corporate DirectorBoard Member Jun 25, 2018
Gregory M Bounds Individual Corporate OfficerCeo Jul 17, 2001 100%
Goshen Medical Center Incorporated Organization, Clinton, NC Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2014 100%
Charlotte W Graham Individual Corporate Director Feb 1, 2008
Diane H Graham Individual Operational/Managerial ControlChief Accounting Officer Dec 27, 2007 100%
Betty S Rose Individual Corporate Director Jan 2, 2011
James Roa Individual Corporate Director Feb 1, 2008
Mattie P Atkinson Individual Corporate OfficerCo Chair of Board Feb 1, 2008

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Goshen Medical Center-Whiteville Mobile UnitWhiteville, NC, CCN 341007 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2012
Goshen Medical Center-Cape FearFayetteville, NC, CCN 341012 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 2014
Goshen Medical Center-New BernNew Bern, NC, CCN 341022 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 25, 2014
Goshen Medical Center - DunnDunn, NC, CCN 341083 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 4, 2017
Goshen Medical Center - New BernNew Bern, NC, CCN B61075 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 2, 2025
Goshen Medical Center - WilmingtonWilmington, NC, CCN B61090 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1023424686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 187",
            "city": "FAISON",
            "state": "NC",
            "postal_code": "283410187",
            "telephone_number": "910-267-0421",
            "fax_number": "910-267-8683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 FAIRVIEW ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282312",
            "telephone_number": "910-596-2400",
            "fax_number": "910-267-8933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOSHEN MEDICAL CENTER, INC",
        "enumeration_date": "2014-07-03",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "910-267-8252",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center - Fairview",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Goshen Medical Center - Fairview",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, NC

Sources for this page

Verify at the official NPI Registry.