GOSHEN MEDICAL CENTER - KENANSVILLE
NPI 1093203473
Clinic/Center - Federally Qualified Health Center (FQHC) in Kenansville, NC

Active since May 01, 2018CLIA 34D1105946 · Microscopy
102 N MAIN ST, SUITE 2, KENANSVILLE, NC 28349(910) 275-0195(910) 275-0192 Get Directions Write a Review

NPPES record last updated: September 27, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 27, 2021, May 3, 2018 (2 updates tracked since 2018).

About Goshen Medical Center - Kenansville NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GOSHEN MEDICAL CENTER - KENANSVILLE (NPI 1093203473) is a healthcare organization registered as a federally qualified health center (fqhc) in Kenansville, North Carolina and active in the NPI registry since May 2018. The organization holds a CLIA Microscopy certificate valid through September 30, 2027 and lists Gregory M Bounds, Ceo, as its authorized official.

NPPES Registry Identity

NPI1093203473
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameGOSHEN MEDICAL CENTER INCORPORATED
Location Address102 N MAIN ST, SUITE 2Kenansville, NC 28349-0001
Mailing AddressPo Box 187Faison, NC 28341-0187 · (910) 267-2042
Fax(910) 275-0192
Organization SubpartNo
Authorized OfficialGregory M BoundsCeo · (910) 267-1237
Enumeration DateMay 1, 2018
Last NPPES UpdateSeptember 27, 20212 updates tracked since enumeration
NPPES CertifiedSeptember 27, 2021
✔ NPI 1093203473 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X
102 N MAIN ST, Kenansville, NC 28349

Other Names 1

Doing Business AsGoshen Medical Center - Kenansville

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Goshen Medical Center - Kenansville is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNorth CarolinaEnrollment IDO20040102000726Non-DME Part B · Clinic/Group PracticeDue dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

173

Medicare enrollment records show 173 clinicians reassign Medicare billing to Goshen Medical Center - Kenansville, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 9 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 8

Nurse Practitioner128
Family Practice17
Dentist8
Internal Medicine8
Clinical Social Worker6
General Practice3
Pediatric Medicine2
Emergency Medicine1

Nearest to this location (20)

See all 173
Nurse Practitioner
NPI 1750849758
102 N MAIN STREET SUITE 2
Kenansville, NC 28349
(910) 335-2360
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1861697310
140 LIMESTONE RD
Kenansville, NC 28349
(910) 275-0195
✔ PECOS✔ Accepts Medicare0.1 mi
Internal Medicine
NPI 1740264084
214 DUPLIN ST
Kenansville, NC 28349
(910) 296-1811
✔ PECOS✔ Accepts Medicare0.2 mi
Nurse Practitioner
NPI 1144000878
401 N MAIN ST
Kenansville, NC 28349
(910) 296-0941
✔ PECOS✔ Accepts Medicare0.2 mi
Family Practice
NPI 1205417722
748 KENANSVILLE BYP
Kenansville, NC 28349
(910) 296-8080
✔ PECOS✔ Accepts Medicare1.9 mi
Nurse Practitioner
NPI 1174478309
603 E COLLEGE ST
Warsaw, NC 28398
(910) 293-3900
✔ PECOS7.4 mi
Nurse Practitioner
NPI 1467411215
603 E COLLEGE ST
Warsaw, NC 28398
(910) 659-1088
✔ PECOS7.4 mi
Nurse Practitioner
NPI 1649397357
113 S PINE ST
Warsaw, NC 28398
(910) 293-7246
✔ PECOS7.7 mi
Nurse Practitioner
NPI 1790478931
112 E PARK DR
Beulaville, NC 28518
(910) 777-5888
✔ PECOS✔ Accepts Medicare10.0 mi
Nurse Practitioner
NPI 1922125087
119 CROSSOVER RD
Beulaville, NC 28518
(910) 298-3125
✔ PECOS✔ Accepts Medicare11 mi
Family Practice
NPI 1346323375
119 CROSSOVER RD
Beulaville, NC 28518
(910) 298-3125
✔ PECOS✔ Accepts Medicare11 mi
Family Practice
NPI 1154404176
119 CROSSOVER RD
Beulaville, NC 28518
(910) 298-3125
✔ PECOS11 mi
Nurse Practitioner
NPI 1245862424
119 CROSSOVER RD
Beulaville, NC 28518
(910) 298-3125
✔ PECOS11 mi
Nurse Practitioner
NPI 1861069486
119 CROSSOVER RD
Beulaville, NC 28518
(312) 591-0298
✔ PECOS✔ Accepts Medicare11 mi
Dentist
NPI 1396533568
460 SW CENTER ST
Faison, NC 28341
(910) 267-0951
✔ PECOS14 mi
Dentist
NPI 1396482295
460 SW CENTER ST
Faison, NC 28341
(910) 267-0951
✔ PECOS14 mi
Internal Medicine
NPI 1073684015
444 SW CENTER ST.
Faison, NC 28341
(910) 267-0421
✔ PECOS✔ Accepts Medicare14 mi
Internal Medicine
NPI 1356682579
444 SW CENTER ST
Faison, NC 28341
(910) 267-0421
✔ PECOS✔ Accepts Medicare14 mi
General Practice
NPI 1699169748
102 W MAIN ST
Wallace, NC 28466
(910) 659-3816
✔ PECOS✔ Accepts Medicare16 mi
Family Practice
NPI 1629189279
120 SOUTHWOOD DR
Clinton, NC 28328
(910) 592-7981
✔ PECOS20 mi
See all 173 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 34D1105946

Goshen Medical Center - Kenansville · Kenansville, NC
Active · expires Sep 30, 2027
CLIA Number34D1105946
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateOctober 1, 2025
Certificate Expiration DateSeptember 30, 2027
Laboratory DirectorCarl Danny Pate
Laboratory Phone(910) 335-2360
Laboratory LocationGoshen Medical Center - Kenansville102 N Main Street, Kenansville, NC 28349
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Goshen Medical Center Incorporated's NPI number?

The NPI number for Goshen Medical Center Incorporated is 1093203473. It was assigned to this organization in the NPPES registry on May 1, 2018. The provider is doing business as Goshen Medical Center - Kenansville.

Where is Goshen Medical Center Incorporated located?

Goshen Medical Center Incorporated is located at 102 N Main St Suite 2, Kenansville, NC 28349. The listed phone number is (910) 275-0195.

What is Goshen Medical Center Incorporated's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Goshen Medical Center Incorporated enrolled in Medicare?

Yes. Goshen Medical Center Incorporated is registered in the Medicare PECOS enrollment system.

When is Goshen Medical Center Incorporated's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (North Carolina, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Goshen Medical Center Incorporated?

According to the CMS Revalidation Reassignment List (October 2026 release), 173 clinicians in 8 Medicare specialties reassign their Medicare billing to Goshen Medical Center Incorporated. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (128), Family Practice (17) and Dentist (8). Of these, 1 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Goshen Medical Center Incorporated hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 34D1105946) is associated with this NPI, valid through September 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Goshen Medical Center Incorporated accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and Cigna Healthcare list Goshen Medical Center Incorporated as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Goshen Medical Center Incorporated was last updated on September 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.