NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

Doing business as Goshen Medical Center - Kenansville

  • Federally Qualified Health Center (FQHC)
  • Kenansville, NC
National Provider Identifier
1093203473
Registry record updated Sep 27, 2021
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
Doing business as
Goshen Medical Center - Kenansville
Practice address
102 N Main St
Suite 2
Kenansville, NC 28349-0001
Phone
(910) 275-0195
Fax
(910) 275-0192
NPI assigned
May 1, 2018
Last updated
Sep 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Authorized official

Name
Gregory M Bounds
Title
Ceo
Phone
(910) 267-1237

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

102 N Main St
Suite 2
Kenansville, NC 28349-0001

Mailing address

PO Box 187
Faison, NC 28341-0187
Phone (910) 267-2042

Other names 1

  • Goshen Medical Center - Kenansville 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…
O20180626002057 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Kenansville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093203473. Details of each certification follow.

Federally qualified health center certification: CCN 341089

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER - KENANSVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 26, 2018
Last certification
Jun 26, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
102 N Main St
Ste 1&2
Kenansville, NC 28349-8966

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
34D1105946Goshen Medical Center -102 N Main Street, Kenansville, NC 28349Provider-performed microscopySep 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Goshen Medical Center I42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Ownership & related parties

All disclosed owners & managing parties 10

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 W-2 Managing EmployeeDirector of Operations Sep 27, 2001
Chester Aycock Individual Corporate OfficerChairman Feb 1, 2008
Tanty Freeman Individual Corporate Director Feb 1, 2008
Patricia a Davis Individual Corporate OfficerSecretary Feb 1, 2008
Gregory M Bounds Individual Corporate OfficerCeo Jul 17, 2001
W-2 Managing EmployeeCeo Jul 17, 2001
Operational/Managerial ControlCeo Jul 17, 2001
Charlotte W Graham Individual Corporate DirectorBoard Member Feb 1, 2008
Diane H Graham Individual Corporate OfficerChief Accounting Officer Dec 27, 2007
W-2 Managing EmployeeChief Accounting Officer Dec 27, 2007
Operational/Managerial ControlChief Accounting Officer Dec 27, 2007
Betty S Rose Individual Corporate DirectorBoard Member Jan 2, 2011
James Roa Individual Corporate DirectorBoard Member Feb 1, 2008
Mattie P Atkinson Individual Corporate OfficerCo-Chairperson Feb 1, 2001

All facility ownership & control disclosures 7

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-FairviewClinton, NC, CCN 341019 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 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

Practitioners & affiliated clinicians

Practitioners 1

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": "1525132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1093203473",
    "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": "910-267-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N MAIN ST",
            "address_2": "SUITE 2",
            "city": "KENANSVILLE",
            "state": "NC",
            "postal_code": "283490001",
            "telephone_number": "910-275-0195",
            "fax_number": "910-275-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-01",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "BOUNDS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-267-1237"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center - Kenansville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenansville, NC

Sources for this page

Verify at the official NPI Registry.