Gaston Family Health Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

GASTON FAMILY HEALTH SERVICES, INC.

Doing business as

Kintegra at South Davie Middle

Practice address

197 S Davie Dr
Mocksville, NC 27028-2927

Phone

(336) 751-5941

Fax

(336) 751-5656

NPI assigned

Jul 7, 2021

Organization subpart

Yes

Parent organization

GASTON FAMILY HEALTH SERVICES, INC.As reported in NPPES

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

Authorized official

Name

Sharmila Alexander Anderson

Title

Medical Coding & Billing Supervisor

Phone

(704) 874-1907

Specialties & licenses 1

Addresses

Other names 1

• Kintegra at South Davie Middle Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 861825

Legal name

KINTEGRA AT SOUTH DAVIE MIDDLE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 7, 2021

Last certification

Oct 7, 2021

Ownership / control type

For profit – corporation

Facility address

197 S Davie Drive
Mocksville, NC 27028

Part of

Gaston Family Health SE

Locations

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625616000000",
    "number": "1114598497",
    "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": "197 S DAVIE DR",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282927",
            "telephone_number": "336-751-5941",
            "fax_number": "336-751-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2021-07-07",
        "last_updated": "2021-07-07",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "MEDICAL CODING & BILLING 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 at South Davie Middle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lori Fraley, PHARMD
• Jason Michael Frost, LCMHC-A, LCAS-A
• Brittany Jordan Fryer, LCSW
• Lauren Kelty Garwood, LCMHC
• Gaston Family Health Services, Inc
• Gaston Family Health Services, Inc.
• Gaston Family Health Services, Inc.
• Gaston Family Health Services, Inc.
• Gaston Family Health Services, Inc.
• Gaston Family Health Services, Inc.

• Federally Qualified Health Center (FQHC) in Mocksville, NC
• Providers in Mocksville, NC by specialty
• Federally Qualified Health Center (FQHC) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.