NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, NC
National Provider Identifier
1669797700
Registry record updated Jan 23, 2012
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
1200 Hargett St
Jacksonville, NC 28540-5933
Phone
(910) 219-1082
Fax
(910) 219-1087
NPI assigned
Apr 1, 2010
Last updated
Jan 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2012

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

Authorized official

Name
Mrs. Reba W. Futrell
Title
Executive Assistant/Credentialing
Phone
(910) 267-8252

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

1200 Hargett St
Jacksonville, NC 28540-5933

Mailing address

444 SW Center St
Faison, NC 28341-8820
Phone (910) 267-0421

Other names 1

  • Goshen Medical Center - New River Other name

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…
O20120305000590 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Jacksonville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669797700. Details of each certification follow.

Federally qualified health center certification: CCN 341970

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER-NEW RIVER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 11, 2012
Last certification
Apr 11, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
1200 Hargett St
Jacksonville, NC 28540-5933

Other NPIs on the same Medicare enrollment 44

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 44

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2023544Goshen Medical Center - New River1200 Hargett St, Jacksonville, NC 28540Certificate of waiverApr 25, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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 W-2 Managing EmployeeDirector of Operations Feb 16, 2017
Mary Mayeau Individual Corporate OfficerBoard Member Jan 1, 2016
Gregory M Bounds Individual Corporate OfficerCeo Jul 17, 2001 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 6

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": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327276800000",
    "number": "1669797700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 SW CENTER ST",
            "city": "FAISON",
            "state": "NC",
            "postal_code": "283418820",
            "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": "1200 HARGETT ST",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285405933",
            "telephone_number": "910-219-1082",
            "fax_number": "910-219-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2012-01-23",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "REBA",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT/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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center - New River",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.