NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Goldsboro, NC
National Provider Identifier
1083739429
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOSHEN MEDICAL CENTER INCORPORATED
Practice address
200 W. Ash St.
Ste#202
Goldsboro, NC 27530-3679
Phone
(919) 731-4941
Fax
(919) 731-2416
NPI assigned
Mar 21, 2007
Last updated
Aug 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

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

Authorized official

Name
Reba W. Futrell
Title
Executive Assistant Credentialing
Phone
(910) 267-9997

Specialties & licenses 1

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

Addresses

Primary practice location

200 W. Ash St.
Ste#202
Goldsboro, NC 27530-3679

Mailing address

412 SW Center St
Faison, NC 28341-8820
Phone (910) 267-0421

Other identifiers 1

IdentifierTypeStateIssuer
344010AMedicaidNC

Other names 1

  • Goshen Medical Center Eastpointe Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 44

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

View all 44

National Provider Directory

National Provider Directory

Locations

200 W Ash St
Ste 202
Goldsboro, NC 27530
Phone (919) 731-4941

Practitioners & affiliated clinicians

Practitioners 2

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": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1083739429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 SW CENTER ST",
            "city": "FAISON",
            "state": "NC",
            "postal_code": "283418820",
            "telephone_number": "910-267-0421",
            "fax_number": "910-267-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W. ASH ST.",
            "address_2": "STE#202",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275303679",
            "telephone_number": "919-731-4941",
            "fax_number": "919-731-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "REBA",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT CREDENTIALING",
        "authorized_official_telephone_number": "910-267-9997"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344010A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center Eastpointe",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.