NPIMap

Organization Active NPI

Goshen Medical Center Incorporated

Doing business as Goshen Medical Center - Mount Olive Mobile Unit

  • Federally Qualified Health Center (FQHC)
  • Mount Olive, NC
National Provider Identifier
1700901287
Registry record updated Nov 2, 2021
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 - Mount Olive Mobile Unit
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
Last updated
Nov 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Authorized official

Name
Gregory M Bounds
Title
Ceo
Phone
(910) 267-1237

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
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 names 2

  • Goshen Medical Center - Mount Olive Mobile Unit Doing business as
  • Community Health Services 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…
O20100804001270 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 Practice locations: Mount Olive, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700901287. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
325 NC Highway 55 W
Mount Olive, NC 28365-8527

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

Locations

110 N Brown St
Chadbourn, NC 28431
Phone (910) 654-1701

412 SW Center St
Faison, NC 28341

109 S Sycamore St
Fremont, NC 27830
Phone (919) 242-4382

102 Main St
Ste 1
Kenansville, NC 28349
Phone (910) 275-0195

811 E US Highway 74
Rockingham, NC 28379
Phone (910) 342-8796

360 E Charity Rd
Rose Hill, NC 28458
Phone (910) 289-3086

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 Corporate OfficerDirector of Operations Feb 1, 2017
W-2 Managing EmployeeDirector of Operations Feb 1, 2017
Operational/Managerial ControlDirector of Operations Feb 1, 2017
Mary Mayeau Individual Corporate Officer Jan 1, 2016
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 5

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": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1700901287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 SW CENTER ST",
            "city": "FAISON",
            "state": "NC",
            "postal_code": "283418820",
            "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": "325 NC HIGHWAY 55 W",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283658527",
            "telephone_number": "919-658-5900",
            "fax_number": "919-658-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "BOUNDS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-267-1237"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center - Mount Olive Mobile Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Olive, NC

Sources for this page

Verify at the official NPI Registry.