NPIMap

Organization Active NPI

Immediate Care of Goldsboro, PLLC

  • Emergency Care Clinic/Center
  • Goldsboro, NC
National Provider Identifier
1952397028
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
Legal business name
IMMEDIATE CARE OF GOLDSBORO, PLLC
Practice address
2604 Medical Office PL
Goldsboro, NC 27534
Phone
(919) 580-0004
Fax
(919) 580-9099
NPI assigned
Sep 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Dr. Terry A Grant, MDNPI 1598761892
Title
President
Phone
(919) 580-0004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Emergency Care Clinic/Center 261QE0002X Primary

Addresses

Primary practice location

2604 Medical Office PL
Goldsboro, NC 27534

Mailing address

2604 Medical Office PL
Goldsboro, NC 27534
Phone (919) 580-0004

Other practice location 1

2604 Medical Office Pl
Goldsboro, NC 27534-9417
Phone (919) 580-0004

Other identifiers 2

IdentifierTypeStateIssuer
0250UOtherBLUE CROSS BLUE SHIELD
890250UMedicaidNC

Other names 1

  • CORRECT LEGAL BUSINESS NAME Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000769 NC Part B Supplier - Clinic/Group Practice 5991603979 Receives reassigned benefits from 17 practitioners
Practice locations: Goldsboro, NC

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
34D0937288Immediate Care of Goldsboro2604 Medical Office Place, Goldsboro, NC 27534Certificate of waiverApr 19, 2027

National Provider Directory

National Provider Directory

Locations

2604 Medical Office Pl
Goldsboro, NC 27534
Phone (919) 580-0004

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1952397028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2604 Medical Office Pl",
            "address_purpose": "LOCATION",
            "city": "Goldsboro",
            "state": "NC",
            "postal_code": "275349417",
            "country_code": "US",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMMEDIATE CARE OF GOLDSBORO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-580-0004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0250U",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890250U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORRECT LEGAL BUSINESS NAME",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CORRECT LEGAL BUSINESS NAME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.