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 Pinebrook Elementary

Practice address

477 Pinebrook School Rd
Mocksville, NC 27028-7749

Phone

(336) 998-3868

NPI assigned

Jun 27, 2022

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 Billing & Coding Supervisor

Phone

(704) 874-1907

Specialties & licenses 1

Addresses

Other names 1

• Kintegra at Pinebrook Elementary Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Federally qualified health center certification: CCN 341816

Legal name

GASTON FAMILY HEALTH SERVICES INC

Doing business as

KINTEGRA AT PINEBROOKE ELEMENTARY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 13, 2022

Last certification

Oct 13, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 28, 1991 in NC

Enrollment address

477 Pinebrook School Rd
Mocksville, NC 27028-7749

Part of

Gaston Family Health SE

Locations

All disclosed owners & managing parties 19

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

Owners & managing parties with NPI records 1

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

• Ralph L Bentley, M.D.

  • Pediatrics Physician
  • Statesville, NC
  • NPI 1912999681

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1184356305",
    "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": "477 PINEBROOK SCHOOL RD",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270287749",
            "telephone_number": "336-998-3868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2022-06-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-20",
        "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 at Pinebrook Elementary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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.
• 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 Jun 27, 2022; 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.