NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Tabor City, NC
National Provider Identifier
1295113371
Registry record updated Dec 14, 2017
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
270 N US 701 Bypass
Tabor City, NC 28463-2705
Phone
(910) 653-1901
Fax
(910) 267-8935
NPI assigned
May 11, 2015
Last updated
Dec 14, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
GOSHEN MEDICAL CENTER INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 14, 2017

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

Authorized official

Name
Mr. Greg M Bounds
Title
Ceo
Phone
(910) 289-1416

Specialties & licenses 1

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

Addresses

Primary practice location

270 N US 701 Bypass
Tabor City, NC 28463-2705

Mailing address

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

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…
O20150710001386 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Tabor City, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295113371. Details of each certification follow.

Federally qualified health center certification: CCN 341030

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER-TABOR CITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2015
Last certification
Jul 10, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
270 N US Highway 701 Byp
Tabor City, NC 28463-8378

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
Tax ID family
Goshen Medical Ctr42 organizations share this tax ID, including this one
Part of
Goshen Medical Ctr

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 11

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 OfficerOfficer Feb 1, 2017
W-2 Managing EmployeeOfficer Feb 1, 2017
Operational/Managerial ControlOfficer Feb 1, 2017
Chester Aycock Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Tanty Freeman Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Patricia a Davis Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Gregory M Bounds Individual Corporate OfficerCeo Jul 17, 2001 100%
W-2 Managing EmployeeCeo Jul 17, 2001 100%
Charlotte W Graham Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Ruth M Diaz Individual Corporate DirectorBoard Member Sep 16, 2014 100%
Diane H Graham Individual Operational/Managerial ControlChief Accounting Officer Dec 27, 2007 100%
Betty S Rose Individual Corporate DirectorBoard Member Jan 2, 2011 100%
James Roa Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Mattie P Atkinson Individual Corporate DirectorBoard Member Feb 1, 2008 100%

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 5

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": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513209600000",
    "number": "1295113371",
    "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": "270 N US 701 BYPASS",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284632705",
            "telephone_number": "910-653-1901",
            "fax_number": "910-267-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "enumeration_date": "2015-05-11",
        "last_updated": "2017-12-14",
        "status": "A",
        "authorized_official_last_name": "BOUNDS",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-289-1416",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tabor City, NC

Sources for this page

Verify at the official NPI Registry.