NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Goldsboro, NC
National Provider Identifier
1255456794
Registry record updated Oct 26, 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
2701 Medical Office PL
Goldsboro, NC 27534-9458
Phone
(919) 739-8680
Fax
(919) 739-7650
NPI assigned
Mar 21, 2007
Last updated
Oct 26, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 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 Primary

Addresses

Primary practice location

2701 Medical Office PL
Goldsboro, NC 27534-9458

Mailing address

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

Other names 1

  • Goshen Medical Center Goldsboro Other name

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…
O20060503000037 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Goldsboro, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255456794. Details of each certification follow.

Federally qualified health center certification: CCN 341905

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER GOLDSBORO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 8, 2006
Last certification
May 8, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
2701 Medical Office Place
Goldsboro, NC 27534-9458

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

104 Adair Dr
#A
Goldsboro, NC 27530
Phone (919) 648-4435

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 Corporate OfficerDirector of Operations Feb 1, 2017
Operational/Managerial ControlDirector of Operations Feb 1, 2017
Chester Aycock Individual Corporate DirectorBoard Member Feb 1, 2008
Tanty Freeman Individual Corporate DirectorBoard Member Feb 1, 2008
Patricia a Davis Individual Corporate DirectorBoard Member 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 DirectorBoard Member 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 DirectorBoard Member Feb 1, 2008

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 9

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": "1288051200000",
    "number": "1255456794",
    "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": "910-267-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349458",
            "telephone_number": "919-739-8680",
            "fax_number": "919-739-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2010-10-26",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center Goldsboro",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.