Goshen Medical Center Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Southport, NC
NPI 1548711963 · NPPES record last updated May 29, 2019
Key facts
- NPI
- 1548711963
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GOSHEN MEDICAL CENTER INCORPORATED
- Practice address
- 4654 Long Beach Rd SE
Southport, NC 28461-8799 - Phone
- (910) 457-0070
- NPI assigned
- Oct 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Greg Bounds
- Title
- Ceo
- Phone
- (910) 267-1942
Other NPIs on the same Medicare enrollment 44
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0968311 | Goshen Medical Center Southport | Certificate of waiver | Jul 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341057
- Legal name
- GOSHEN MEDICAL CENTER INCORPORATED
- Doing business as
- GOSHEN MEDICAL CENTER - SOUTHPORT
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 10, 2017
- Last certification
- Feb 10, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 29, 1979 in NC
- Enrollment address
- 4654 Long Beach Rd SE
Southport, NC 28461-8799
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Rhonda Barwick |
W-2 Managing Employee |
Feb 1, 2017 | |
| Mary Mayeau |
Corporate Officer | Jan 1, 2016 | |
| Gregory M Bounds |
Corporate Officer |
Jul 17, 2001 | 100% |
| W-2 Managing Employee |
Jul 17, 2001 | 100% |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Goshen Medical Center-Whiteville Mobile Unit |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2012 |
| Goshen Medical Center-Cape Fear |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2014 |
| Goshen Medical Center-New Bern |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 25, 2014 |
| Goshen Medical Center-Fairview |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2014 |
| Goshen Medical Center - Dunn |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 4, 2017 |
| Goshen Medical Center - New Bern |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 2, 2025 |
| Goshen Medical Center - Wilmington |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20170203002345 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 3173434479 | Practice locations: Southport, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
4654 Long Beach Rd SE
Southport, NC 28461-8799
Mailing address
444 SW Center St
Faison, NC 28341-8820
Phone (910) 267-0421
Other providers in Southport, NC
- Jean Gabriel
- Galloway Sands, LLC
- Galloway Sands, LLC
- Nathan Garrett
- Sue Leeuwenburg Gibson
- Jeremy Brian Grissett
- Regina Z Gum
- Lenard Clifton Hammond
- Deborah Hanna
- Harmony Dental of Southport
All providers in Southport, NC · Federally Qualified Health Center (FQHC) 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 May 29, 2019. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.