NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

Doing business as Goshen Medical Center Beulaville

  • Federally Qualified Health Center (FQHC)
  • Beulaville, NC
National Provider Identifier
1639294309
Registry record updated Mar 2, 2015
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
Doing business as
Goshen Medical Center Beulaville
Practice address
119 Crossover Rd
Beulaville, NC 28518-8801
Phone
(910) 298-3125
Fax
(910) 267-8980
NPI assigned
Mar 20, 2007
Last updated
Mar 2, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
GOSHEN MEDICAL CENTER INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Mrs. Rebecca M. Brown
Title
Credentialing
Phone
(910) 267-8252

Specialties & licenses 1

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

Addresses

Primary practice location

119 Crossover Rd
Beulaville, NC 28518-8801

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
014VEOtherNCBCBS
344595AMedicaidNC

Other names 1

  • Goshen Medical Center Beulaville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030908000017 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Beulaville, NC
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639294309. Details of each certification follow.

Federally qualified health center certification: CCN 341873

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER BEULAVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 26, 2003
Last certification
Sep 26, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
119 Crossover Rd
Beulaville, NC 28518-8801

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 Center I42 organizations share this tax ID, including this one
Part of
Goshen Medical Center I

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 2

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 DirectorBoard Member Feb 1, 2017
Gregory M Bounds Individual Corporate OfficerCeo Jul 17, 2001
W-2 Managing EmployeeCeo Jul 17, 2001
Operational/Managerial ControlCeo Jul 17, 2001

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 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1639294309",
    "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": "119 CROSSOVER RD",
            "city": "BEULAVILLE",
            "state": "NC",
            "postal_code": "285188801",
            "telephone_number": "910-298-3125",
            "fax_number": "910-267-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "enumeration_date": "2007-03-20",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "910-267-8252",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "014VE",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344595A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center Beulaville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beulaville, NC

Sources for this page

Verify at the official NPI Registry.