NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as Catawba Valley Family Medicine - Taylorsville

  • Federally Qualified Health Center (FQHC)
  • Taylorsville, NC
National Provider Identifier
1104388263
Registry record updated Apr 5, 2019
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
Catawba Valley Family Medicine - Taylorsville
Practice address
50 Macedonia Church Rd
Taylorsville, NC 28681-8414
Phone
(828) 632-7076
Fax
(828) 632-7028
NPI assigned
Apr 5, 2019
Last updated
Apr 5, 2019By 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 Apr 5, 2019

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

Authorized official

Name
Sharmila Alexander Anderson
Title
Business Services Administrator
Phone
(704) 874-1907

Specialties & licenses 1

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

Addresses

Primary practice location

50 Macedonia Church Rd
Taylorsville, NC 28681-8414

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1904

Other names 1

  • Catawba Valley Family Medicine - Taylorsville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190823000554 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Taylorsville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104388263. Details of each certification follow.

Federally qualified health center certification: CCN 341120

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
CATAWBA VALLEY FAMILY MEDICINE - TAYLORSVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 23, 2019
Last certification
Aug 23, 2019
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1991 in NC
Enrollment address
50 Macedonia Church Rd
Taylorsville, NC 28681-8414

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health Ser267 organizations share this tax ID, including this one
Part of
Gaston Family Health Ser

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 DirectorBoard Member Oct 8, 2022
Robert Jones Individual Corporate Director Jul 21, 2014
Jennifer Foster McCracken Individual Corporate DirectorBoard Member Oct 8, 2022
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 DirectorBoard Member Oct 8, 2022
Paula Ratchford Black Individual Corporate DirectorBoard Member Oct 8, 2022
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.

NPI Registry JSON

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1104388263",
    "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",
            "telephone_number": "704-874-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MACEDONIA CHURCH RD",
            "city": "TAYLORSVILLE",
            "state": "NC",
            "postal_code": "286818414",
            "telephone_number": "828-632-7076",
            "fax_number": "828-632-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2019-04-05",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINESS SERVICES ADMINISTRATOR",
        "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": "Catawba Valley Family Medicine - Taylorsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylorsville, NC

Sources for this page

Verify at the official NPI Registry.