Gaston Family Health Services, Inc.

Key facts

NPI: 1194450130
Entity type: Organization (NPI type 2)
Primary specialty: Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name: GASTON FAMILY HEALTH SERVICES, INC.
Practice address: 1133 Ratchford Dr
Dallas, NC 28034-6500
Phone: (704) 922-5285
Fax: (704) 922-7486
NPI assigned: Jul 22, 2022
Organization subpart: Yes
Parent organization (as reported): GASTON FAMILY HEALTH SERVICES, INC.

Authorized official

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

Owners & managing parties with NPI records 2

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

CMS ownership CORPORATE DIRECTOR
Kristin Hayes Monza, NP Nurse Practitioner · Charlotte, NC · NPI 1437692035

CMS ownership CORPORATE DIRECTOR

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NC

Federally qualified health center certification: CCN 861114

Legal name: GASTON FAMILY HEALTH SERVICES INC
Doing business as: KINTEGRA AT NORTH GASTON HIGH
Certification status: Active
Provider type (POS): Federally qualified health center
Participating since: Feb 3, 2023
Last certification: Feb 3, 2023
Ownership / control type: For profit – corporation
Organization structure: Corporation · Non-profit
Incorporated: Jun 28, 1991 in NC
Enrollment address: 1133 Ratchford Dr
Dallas, NC 28034-6500

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.

Name	Role	Since
Shirley Stowe Individual	Corporate Director Board Member	Jul 21, 2014
Harold Thornburg Individual	Corporate Director Board Member	Jan 23, 2019
Sharmila Anderson Individual	W-2 Managing Employee	Jul 2, 2012
Jacobus Dodoo Individual	Corporate Director Board Member	Jul 21, 2014
Charles Luther Moore Individual	Corporate Director Board Member	Sep 28, 2022
John Herrera Individual	Corporate Director Board Member	Jul 21, 2014
James Hodges Individual	Corporate Director Board Member	Jul 21, 2014
Betty Worthy Individual	Corporate Director Board Member	Sep 26, 2018
Theresa Matthews Individual	Corporate Director Board Member	Jul 21, 2014
Ralph Luther Bentley Individual	Corporate Director Board Member	Jul 1, 2021
Robert Jones Individual	Corporate Director Board Member	Jul 21, 2014
Jennifer Foster McCracken Individual	Corporate Director Board Member	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 Board Member	Nov 28, 2018
Ami Robinson Steele Individual	Corporate Director Board Member	Apr 27, 2022
Douglas Scarborough Individual	Corporate Director Board Member	Oct 26, 2022
Brian McGinnis Individual	Corporate Director Board Member	Jul 21, 2014
Ronald Worley Individual	Corporate Director Board Member	Nov 28, 2018
Kristin Hayes Monza Individual	Corporate Director Board Member	Apr 27, 2022
Michele Knapp Individual	Corporate Director Board Member	May 26, 2021
Paula Ratchford Black Individual	Corporate Director Board Member	Feb 25, 2021
Phillip Lee Hinely Individual	Corporate Director Board Member	Jul 21, 2014
Ramona Neal Individual	Corporate Director Board Member	Jul 21, 2014

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20230213000237	NC	Part a Provider - Federally Qualified Health Center (FQHC)	5496733925	Practice locations: Dallas, NC

National Provider Directory

Part of: Gaston Family Health SE

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Federally Qualified Health Center (FQHC)	261QF0400X			Yes

Addresses

Primary practice location

1133 Ratchford Dr
Dallas, NC 28034-6500

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358

Other names

Kintegra at North Gaston High Doing business as

Other providers in Dallas, NC

All providers in Dallas, NC · Federally Qualified Health Center (FQHC) in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.