NPIMap

Organization Active NPI

Goshen Medical Center, Inc

Doing business as Goshen Medical Center - Dunn

  • Federally Qualified Health Center (FQHC)
  • Dunn, NC
National Provider Identifier
1780193557
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOSHEN MEDICAL CENTER, INC
Doing business as
Goshen Medical Center - Dunn
Practice address
801 Tilghman Dr Ste a
Dunn, NC 28334-4958
Phone
(910) 892-6500
Fax
(910) 302-5897
NPI assigned
Sep 25, 2017
Last updated
Dec 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Authorized official

Name
Greg Bounds
Title
Ceo
Phone
(910) 267-2042

Specialties & licenses 1

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

Addresses

Primary practice location

801 Tilghman Dr Ste a
Dunn, NC 28334-4958

Mailing address

PO Box 187
Faison, NC 28341-0187
Phone (910) 267-2042

Other names 1

  • Goshen Medical Center - Dunn Doing business as

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…
O20171220002667 NC Part A Provider - Federally Qualified Health Center (FQHC) 3173434479 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dunn, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780193557. Details of each certification follow.

Federally qualified health center certification: CCN 341083

Legal name
GOSHEN MEDICAL CENTER INCORPORATED
Doing business as
GOSHEN MEDICAL CENTER - DUNN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 21, 2018
Last certification
Mar 21, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in NC
Enrollment address
801 Tilghman Dr
Ste a
Dunn, NC 28334-4958

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

408 Fairview St
Clinton, NC 28328
Phone (910) 596-2400

Ownership & related parties

All disclosed owners & managing parties 11

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 Dec 4, 2017
Chester Aycock Individual Corporate DirectorChairman Feb 1, 2006 100%
Tanty Freeman Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Patricia a Davis Individual Corporate DirectorSecretary Feb 1, 2008 100%
Gregory M Bounds Individual Corporate OfficerCeo Jan 2, 2004
W-2 Managing EmployeeCeo Jan 2, 2004
Operational/Managerial ControlCeo Jan 2, 2004
Goshen Medical Center Incorporated Organization, Dunn, NC Non-profit 5% Or Greater Direct Ownership Interest Dec 4, 2017 100%
Charlotte W Graham Individual Corporate DirectorBoard Member Feb 1, 2008 100%
Diane H Graham Individual Corporate OfficerChief Accounting Officer Dec 27, 2007
W-2 Managing EmployeeChief Accounting Officer Dec 27, 2007
Operational/Managerial ControlChief Accounting Officer Dec 27, 2007
Betty S Rose Individual Corporate DirectorBoard Member Jan 2, 2011 100%
James Roa Individual Corporate DirectorTreasurer Feb 1, 2008 100%
Mattie P Atkinson Individual Corporate DirectorCo-Chairman Feb 1, 2008 100%

Practitioners & affiliated clinicians

Practitioners 10

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": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1780193557",
    "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": "910-267-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 TILGHMAN DR STE A",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "283344958",
            "telephone_number": "910-892-6500",
            "fax_number": "910-302-5897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-25",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "BOUNDS",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-267-2042"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goshen Medical Center - Dunn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dunn, NC

Sources for this page

Verify at the official NPI Registry.