Goldsboro Pediatrics PA
Organization Active NPI Rural Health Clinic/Center · Lagrange, NC
NPI 1497523625 · NPPES record last updated Feb 10, 2026
Key facts
- NPI
- 1497523625
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GOLDSBORO PEDIATRICS PA
- Practice address
- 114 E Railroad Street
Lagrange, NC 28551 - Phone
- (252) 566-5999
- Fax
- (252) 566-4430
- NPI assigned
- Dec 18, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- GOLDSBORO PEDIATRICS PA
Authorized official
- Name
- Mr. Michael Allen Riddick
- Title
- Practice Manager
- Phone
- (919) 734-4736
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 22
-
Katie Michelle Anthony, ARNP
-
Valerie S Bailey, CPNP
-
Cory Duane Bean, MD
-
Kristen Shayanne Crook, CPNP-PC
-
Ashley Jones Faulkner, FNP-C
-
Lane Natividad, CPNP
-
Susan R Parlow, M.D.
-
Theresa Podbielski, CPNP
-
Joseph W Ponzi, MD
-
Cierra Sullivan, FNP-BC
-
Brandy Leigh Yeh, NP
-
Carey Ziemer, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Rural health clinic certification: CCN 343817
- Legal name
- GOLDSBORO PEDIATRICS PA
- Doing business as
- LAGRANGE PEDIATRICS
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 25, 2026
- Last certification
- Feb 25, 2026
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 114 E Railroad St
La Grange, NC 28551-1800
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Whitney Kirchoff |
5% Or Greater Direct Ownership Interest |
Jan 1, 2023 | 13.57% |
| Corporate Officer |
Jan 1, 2023 | ||
| Siegfried Chang-Rong Yeh |
5% Or Greater Direct Ownership Interest |
Oct 26, 1999 | 13.57% |
| Corporate Officer |
Oct 26, 1999 | ||
| Michael Riddick |
W-2 Managing Employee |
Nov 13, 2009 | |
| Christopher Parks Griffin |
5% Or Greater Direct Ownership Interest |
Sep 30, 2001 | 13.57% |
| Corporate Officer |
Jan 2, 2024 | ||
| Corporate Director |
Jan 2, 2024 | ||
| Bryan Stup |
5% Or Greater Direct Ownership Interest |
Jan 1, 2017 | 13.57% |
| Corporate Officer |
Jan 1, 2017 | ||
| Jennifer Jarrett Hoover |
5% Or Greater Direct Ownership Interest |
Jan 1, 2011 | 13.57% |
| Corporate Officer |
Jan 1, 2011 | ||
| Katherine Tayloe Macdonald |
5% Or Greater Direct Ownership Interest |
Jan 1, 2020 | 13.57% |
| Corporate Officer |
Jan 1, 2020 | ||
| Joseph William Ponzi |
5% Or Greater Direct Ownership Interest |
Jul 1, 1981 | 4.99% |
| Corporate Officer |
Jul 1, 1981 | ||
| Cory Duane Bean |
5% Or Greater Direct Ownership Interest |
Jan 1, 2006 | 13.57% |
| Corporate Officer |
Jan 1, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250609003176 | NC | Part a Provider - Rural Health Clinic | 5799687174 | Practice locations: La Grange, NC |
National Provider Directory
- Tax ID family
- Goldsboro Pediatrics PA
- Part of
- Goldsboro Pediatrics PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
114 E Railroad Street
Lagrange, NC 28551
Mailing address
114 E Railroad Street
Lagrange, NC 28551
Phone (252) 566-5999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8901644 | Medicaid | NC |
Other names
- LAGRANGE PEDIATRICS PA
Other providers in Lagrange, NC
- Ant Mary'S Family Care #1
- Country Pines Inc
- Tanger Lee Jones
- Nova Ic, Inc.
- Marjorie R Rachide
- With a Purpose Family Care, Inc.
All providers in Lagrange, NC · Rural Health Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.