ADAM BROCK GOFORTH
NPI 1356173124
Nurse Practitioner - Psychiatric/Mental Health in Anna, IL
About Adam Brock Goforth NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ADAM BROCK GOFORTH (NPI 1356173124) is an individual psychiatric/mental health provider in Anna, Illinois, licensed in Illinois (209.030398) and active in the NPI registry since August 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Adam Brock Goforth is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Adam Goforth reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Anna, IL 62906
- Reassigned Medicare billing, Illinois enrollment
- 28 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 62906 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Adam Goforth's NPI number?
The NPI number for Adam Goforth is 1356173124. It was assigned to this individual provider in the NPPES registry on August 19, 2024.
Where is Adam Goforth located?
Adam Goforth practices at 513 N Main St, Anna, IL 62906. The listed phone number is (618) 833-4471.
What is Adam Goforth's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Adam Goforth enrolled in Medicare?
Yes. Adam Goforth is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Adam Goforth's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Adam Goforth reassigns Medicare benefits to Rural Health, Inc. (Anna, IL). The 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 Adam Goforth's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Adam Goforth was last updated on December 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.
# Adam Brock Goforth · NPI 1356173124
Psychiatric/Mental Health physician in Anna, Illinois. Individual provider, active in the CMS NPPES registry since August 19, 2024.
## Identity
- **NPI:** 1356173124 (Entity type: Individual)
- **Enumerated:** August 19, 2024
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 209.030398 (Illinois)
- **Sole proprietor:** No
## Practice location
- **Address:** 513 N MAIN ST, Anna, IL 62906-1697
- **Phone:** (618) 833-4471
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Rural Health, Inc. (NPI 1982666384, Anna, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** December 9, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1356173124) · Data from the CMS NPPES public registry.