Adam Brock Goforth

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209.030398 Issued in IL

Practice address

513 N Main St
Anna, IL 62906-1697

Phone

(618) 833-4471

NPI assigned

Aug 19, 2024

Last updated

Dec 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rural Health, Inc.Group PAC ID 6800705427, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rural Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Anna, IL
  • NPI 1982666384
  Medicare reassignment Care Compare group NPD
• Rural Health, Inc.

  dba Rural Health Plus

  • Community/Retail Pharmacy
  • Anna, IL
  • NPI 1801634183
  NPD
• Rural Health, Inc.

  dba Dongola Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Dongola, IL
  • NPI 1366506628
  NPD (past)

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1356173124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061697",
            "telephone_number": "618-833-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOFORTH",
        "first_name": "ADAM",
        "middle_name": "BROCK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-12-09",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.030398",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.505508",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph C Flamm, PA
• Deborah Frankland
• Dennis Edward Gade, LCSW, CADC
• Keeley Glodo, LPN
• Timothy Goad, BGS
• Krystin Angel Grant, CNA
• Krysten Ann Green, MSN,APRN
• H&S Pharmacies, LLC (LTC Medicenter Pharmacy Anna)
• H&S Pharmacies, LLC (MediCenter Pharmacy Anna)
• Tyler Hale

• Psychiatric/Mental Health Nurse Practitioner in Anna, IL
• Providers in Anna, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.