NPIMap

Individual provider Active NPI

Eugenio De Jesus Gonzalez, PAC

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1972522779
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103739 Issued in NC
Practice address
4402 Shipyard Blvd
Wilmington, NC 28403-6161
Phone
(910) 452-7000
NPI assigned
Jul 19, 2006
Last updated
Jun 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103739 NC Primary
Medical Physician Assistant 363AM0700X NC103739 NC

Addresses

Primary practice location

4402 Shipyard Blvd
Wilmington, NC 28403-6161

Mailing address

1135 Military Cutoff Rd Ste 103
Wilmington, NC 28405-3685
Phone (910) 256-6222

Other identifiers 2

IdentifierTypeStateIssuer
0932PAMedicaidSC
1972522779MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070822001402 NC Practitioner - Physician Assistant 5991897837 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fastmed PCGroup PAC ID 9830540558, 174 clinicians

Practice addresses (Care Compare)

202 Village Rd NE
Leland, NC 28451-7414
Phone (910) 782-3600

7010 NC Hwy 751
Durham, NC 27707-5733
Phone (919) 313-3900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
NC103739NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Goshen Medical Center Incorporated Current Accepting new patients
Goshen Medical Center Incorporated CurrentSince Feb 1, 2018 Accepting new patients
Goshen Medical Center Incorporated CurrentSince Feb 1, 2018 Accepting new patients
Southern Living Emergency Physicians LLC Physician Assistant Past Accepting new patients
Bladen Healthcare LLC Past Accepting new patients
South Carolina Em-I Medical Services PC Physician Assistant Past Accepting new patients
Wilmington Health PLLC Past Accepting new patients
Fastmed Primary Care, P.C. Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: egonzalez@goshenmedical.cloudcraftdirect.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1972522779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 MILITARY CUTOFF RD STE 103",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053685",
            "telephone_number": "910-256-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036161",
            "telephone_number": "910-452-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "EUGENIO",
        "middle_name": "DE JESUS",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103739",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "NC103739",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0932PA",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972522779",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.