NPIMap

Organization Active NPI

Gaston Family Health Services Inc

Doing business as Kintegra Family Medicine - Highland

  • Federally Qualified Health Center (FQHC)
  • Gastonia, NC
National Provider Identifier
1174767073
Registry record updated Feb 1, 2021
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 - Highland
Practice address
609 N Highland St
Gastonia, NC 28052-2179
Phone
(704) 772-4700
Fax
(704) 833-1553
NPI assigned
Apr 23, 2009
Last updated
Feb 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Authorized official

Name
Sharmila Alexander Anderson
Title
Business Service Admin
Phone
(704) 874-1907

Specialties & licenses 1

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

Addresses

Primary practice location

609 N Highland St
Gastonia, NC 28052-2179

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
3420154OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Kintegra Family Medicine - Highland Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC3 enrollments

Enrollment records 3

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…
O20090714000202 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Gastonia, NC
O20250502002839 NC Part B Supplier - Pharmacy 5496733925 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lexington, NC; Statesville, NC; Shelby, NC; Lincolnton, NC; Kings Mountain, NC; Gastonia, NC; Asheboro, NC; Charlotte, NC…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174767073. Details of each certification follow.

Federally qualified health center certification: CCN 341945

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
KINTEGRA FAMILY MEDICINE - HIGHLAND
Organization structure
CorporationNon-profit
Incorporated
Sep 2, 1991 in NC
Enrollment address
609 N Highland St
Gastonia, NC 28052-2179

Other NPIs on the same Medicare enrollment 27

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

View all 27

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
34D2134503Kintegra Family Medicine - Highland609 N Highland Street, Gastonia, NC 28052Certificate of waiverAug 2, 2027

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

Locations

609 N Highland St
Gastonia, NC 28052
Phone (704) 772-4700

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Brittany Megan Bonn Individual Corporate DirectorBoard Member Jul 1, 2026
Jennifer Bennett Individual Corporate DirectorBoard Member Jul 1, 2026
Shirley Stowe Individual Corporate DirectorBoard Member Jun 1, 2009
Laura Bradham Clark Individual Corporate DirectorBoard Member Jul 1, 2026
Harold Thornburg Individual Corporate DirectorBoard Member Jan 23, 2019
Charles Luther Moore Individual Corporate DirectorBoard Member Sep 28, 2022
John Herrera Individual Corporate DirectorBoard Member Jul 1, 2014
Thomas Daniel Williams Individual Corporate DirectorBoard Member Jul 1, 2026
Betty Worthy Individual Corporate DirectorBoard Member Sep 26, 2018
Theresa Matthews Individual Corporate DirectorBoard Member Jul 21, 2014
Stephanie Jacques Parent Individual Corporate DirectorBoard Member Jul 1, 2026
Ralph Luther Bentley Individual Corporate DirectorBoard Member Jul 1, 2021
Jennifer Foster McCracken Individual Corporate DirectorBoard Member Jul 24, 2019
Robert Spencer Individual Corporate OfficerCeo Jan 8, 1996
Corporate Director Jun 1, 2009
W-2 Managing Employee Jan 8, 1996
Operational/Managerial Control Jan 8, 1996
James Macomson Individual Corporate DirectorBoard Member Nov 28, 2018
Douglas Scarborough Individual Corporate DirectorBoard Member Oct 26, 2022
Brian McGinnis Individual Corporate DirectorBoard Member Jul 21, 2014
Kristin Hayes Monza Individual Corporate DirectorBoard Member Apr 27, 2022
Michele Knapp Individual Corporate DirectorBoard Member May 26, 2021
Paula Ratchford Black Individual Corporate DirectorBoard Member Feb 25, 2021
Phillip Lee Hinely Individual Corporate DirectorBoard Member Jul 21, 2014
Molly Brown Quackenbush Individual W-2 Managing EmployeeDirector of Credentialing & Clinica Jul 1, 2026
Ramona Neal Individual Corporate DirectorBoard Member Jul 21, 2014
Wendy Martinez Individual Corporate DirectorBoard Member Jul 1, 2026

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 4

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": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1174767073",
    "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",
            "fax_number": "704-864-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 N HIGHLAND ST",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280522179",
            "telephone_number": "704-772-4700",
            "fax_number": "704-833-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES INC",
        "enumeration_date": "2009-04-23",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINESS SERVICE ADMIN",
        "authorized_official_telephone_number": "704-874-1907"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3420154",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kintegra Family Medicine - Highland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.