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ADAM BROCK GOFORTH
NPI 1356173124
Nurse Practitioner - Psychiatric/Mental Health in Anna, IL

Active since August 19, 2024PECOS EnrolledAccepts Medicare Assignment

NPPES record last updated: December 9, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 9, 2024, Sep 3, 2024, Aug 19, 2024 (3 updates tracked since 2024).

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

NPI1356173124
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameADAM BROCK GOFORTH
Location Address513 N MAIN STAnna, IL 62906-1697
Mailing Address513 N Main StAnna, IL 62906-1668
Phone(618) 833-4471
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateAugust 19, 2024
Last NPPES UpdateDecember 9, 20243 updates tracked since enumeration
NPPES CertifiedNovember 15, 2024
✔ NPI 1356173124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in IL · 209.030398
Also ListedRegistered NurseTaxonomy 163W00000X · License 041.505508 (IL)
513 N MAIN ST, Anna, IL 62906
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID8325570104
PECOS Enrollment IDI20241017003122
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

MARLA WILLIAMS
Social Worker (Clinical)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
RURAL HEALTH, INC.
Case Manager/Care Coordinator
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
THOMAS J LARKIN III DMD
Dentist
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
JACOB W RIBBING PA
Physician Assistant
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
KEITH SAMUEL BASS NP-C
Nurse Practitioner (Family)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
DR. MICHAEL PETER HOLUB D.D.S.
Dentist (General Practice)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
JEFFREY ALAN SHERRILL PA-C
Physician Assistant (Medical)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Orthopaedic Surgery
513 N MAIN ST
ANNA, IL 62906
Union County (618) 998-7177

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.

What insurance does Adam Goforth accept?

Health plans from Providence Health Plan list Adam Goforth 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 Adam Goforth was last updated on December 9, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.