Goshen Medical Center Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Mount Olive, NC
NPI 1700901287 · NPPES record last updated Nov 2, 2021
Key facts
- NPI
- 1700901287
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GOSHEN MEDICAL CENTER INCORPORATED
- Practice address
- 325 NC Highway 55 W
Mount Olive, NC 28365-8527 - Phone
- (919) 658-5900
- Fax
- (919) 658-0101
- NPI assigned
- Mar 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Gregory M Bounds
- Title
- Ceo
- Phone
- (910) 267-1237
Other NPIs on the same Medicare enrollment 44
Practitioners 86
-
Rose A Duncan, PA-C
-
Zena Kobaissi, PA-C
-
Malia Suhren, MSW, LCSW
-
Jamie Jones Avery, FNP-C
-
Brittany Bailey, FNP
-
Carolyn Danielle Battle, FNP-BC
-
John D. Beaver, NP
-
Viola Elizabeth Blackwell, FNP-C
-
Galina Bogdanova, MPA-C
-
Angela Maria Bryant, FNP-C
-
Melissa Dawn Cain, FNP-BC
-
Crystal Davis Campbell, DNP, FNP-BC
-
Caitlin Casey, FNP-C
-
Samantha Ruth Ferguson, MSN, CPNP
-
Rosemaree Kathryn Fisher, PA-C
-
Michael T Futrell, AGNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341857
- Legal name
- GOSHEN MEDICAL CENTER INCORPORATED
- Doing business as
- GOSHEN MEDICAL CENTER - MOUNT OLIVE MOBILE UNIT
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 28, 1996
- Last certification
- Oct 28, 1996
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 29, 1979 in NC
- Enrollment address
- 325 NC Highway 55 W
Mount Olive, NC 28365-8527
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Rhonda Barwick |
Corporate Officer |
Feb 1, 2017 | |
| W-2 Managing Employee |
Feb 1, 2017 | ||
| Operational/Managerial Control |
Feb 1, 2017 | ||
| Mary Mayeau |
Corporate Officer | Jan 1, 2016 | |
| Gregory M Bounds |
Corporate Officer |
Jul 17, 2001 | |
| W-2 Managing Employee |
Jul 17, 2001 | ||
| Operational/Managerial Control |
Jul 17, 2001 |
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… |
| O20100804001270 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 3173434479 | Practice locations: Mount Olive, NC |
National Provider Directory
Locations
110 N Brown St
Chadbourn, NC 28431
Phone (910) 654-1701
412 SW Center St
Faison, NC 28341
1200 Hargett St
Jacksonville, NC 28540
Phone (910) 219-1082
4654 Long Beach Rd SE
Southport, NC 28461
Phone (910) 457-0070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
325 NC Highway 55 W
Mount Olive, NC 28365-8527
Mailing address
412 SW Center St
Faison, NC 28341-8820
Phone (910) 267-0421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 344579A | Medicaid | NC | |
| 0168B | Other | NC | BCBS |
Other names
- Goshen Medical Center - Mount Olive Mobile Unit
- Community Health Services
Other providers in Mount Olive, NC
- John Eugene Glennon Jr.
- Goldsboro Pediatrics PA
- Diana Lynora Goodie
- Goshen Medical Center Incorporated
- Goshen Medical Center Incorporated
- Graham New Horizons Inc
- Willam G Graves
- Cynthia Vanessa Guzman
- Lauren Elizabeth Hairr
- Collin Nathaniel Hall
All providers in Mount Olive, 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 Nov 2, 2021. 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.