NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as Kintegra Family Medicine - Fallston

  • Federally Qualified Health Center (FQHC)
  • Lawndale, NC
National Provider Identifier
1043963564
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GASTON FAMILY HEALTH SERVICES, INC.
Doing business as
Kintegra Family Medicine - Fallston
Practice address
5009 Fallston Rd
Lawndale, NC 28090-9585
Phone
(704) 538-8532
NPI assigned
Feb 3, 2022
Last updated
Feb 16, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

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

Authorized official

Name
Sharmila Alexander Anderson
Title
Medical Billing & Coding Supervisor
Phone
(704) 874-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5009 Fallston Rd
Lawndale, NC 28090-9585

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358

Other names 1

  • Kintegra Family Medicine - Fallston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040712000470 NC Part B Supplier - Clinic/Group Practice 5496733925 Receives reassigned benefits from 325 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thomasville, NC; Statesville, NC; Shelby, NC; Newton, NC; Mocksville, NC; Lincolnton, NC; Asheboro, NC; Lexington, NC…
O20220516000213 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Lawndale, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043963564. Details of each certification follow.

Federally qualified health center certification: CCN 861924

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
KINTEGRA FAMILY MEDICINE - FALLSTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 14, 2022
Last certification
Apr 14, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1991 in NC
Enrollment address
5009 Fallston Rd
Lawndale, NC 28090-9585

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

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
34D0243155Kintegra Family Medicine - Fallston5009 Fallston Road, Lawndale, NC 28090Certificate of waiverJul 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health SE264 organizations share this tax ID, including this one
Part of
Gaston Family Health SE

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shirley Stowe Individual Corporate Director Jul 21, 2014
Harold Thornburg Individual Corporate Director Jan 23, 2019
Sharmila Anderson Individual W-2 Managing Employee Jul 2, 2012
Jacobus Dodoo Individual Corporate Director Jul 21, 2014
Charles Luther Moore Individual Corporate DirectorBoard Member Oct 8, 2022
John Herrera Individual Corporate Director Jul 21, 2014
James Hodges Individual Corporate Director Jul 21, 2014
Betty Worthy Individual Corporate Director Sep 26, 2018
Theresa Matthews Individual Corporate Director Jul 21, 2014
Ralph Luther Bentley Individual Corporate Director Jul 1, 2021
Robert Jones Individual Corporate Director Jul 21, 2014
Jennifer Foster McCracken Individual Corporate Director Jul 24, 2019
Robert Spencer Individual Corporate Officer Jan 8, 1996
Corporate Director Jan 8, 1996
W-2 Managing Employee Jan 8, 1996
Operational/Managerial Control Jan 8, 1996
James Macomson Individual Corporate Director Nov 28, 2018
Ami Robinson Steele Individual Corporate DirectorBoard Member Oct 8, 2022
Douglas Scarborough Individual Corporate DirectorBoard Member Oct 8, 2022
Brian McGinnis Individual Corporate Director Jul 21, 2014
Ronald Worley Individual Corporate Director Nov 28, 2018
Kristin Hayes Monza Individual Corporate DirectorBoard Member Oct 8, 2022
Michele Knapp Individual Corporate Director May 26, 2021
Paula Ratchford Black Individual Corporate Director Feb 25, 2021
Phillip Lee Hinely Individual Corporate Director Jul 21, 2014
Ramona Neal Individual Corporate Director Jul 21, 2014

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1043963564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5009 FALLSTON RD",
            "city": "LAWNDALE",
            "state": "NC",
            "postal_code": "280909585",
            "telephone_number": "704-538-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "MEDICAL BILLING & CODING SUPERVISOR",
        "authorized_official_telephone_number": "704-874-1907"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kintegra Family Medicine - Fallston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawndale, NC

Sources for this page

Verify at the official NPI Registry.