Gaston Family Health Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Newton, NC
NPI 1194457325 · NPPES record last updated Jun 27, 2022
Key facts
- NPI
- 1194457325
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GASTON FAMILY HEALTH SERVICES, INC.
- Practice address
- 3431 Plateau Rd
Newton, NC 28658-8809 - Phone
- (704) 462-1827
- NPI assigned
- Jun 27, 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
-
Ralph L Bentley, M.D.
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Federally qualified health center certification: CCN 341181
- Legal name
- GASTON FAMILY HEALTH SERVICES INC
- Doing business as
- KINTEGRA AT JACOB'S FORK MIDDLE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 12, 2022
- Last certification
- Oct 12, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 28, 1991 in NC
- Enrollment address
- 3431 Plateau Rd
Newton, NC 28658-8809
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Shirley Stowe |
Corporate Director |
Jul 21, 2014 | |
| Harold Thornburg |
Corporate Director |
Jan 23, 2019 | |
| Sharmila Anderson |
W-2 Managing Employee | Jul 2, 2012 | |
| Jacobus Dodoo |
Corporate Director | Jul 21, 2014 | |
| Charles Luther Moore |
Corporate Director |
Oct 8, 2022 | |
| John Herrera |
Corporate Director | Jul 21, 2014 | |
| James Hodges |
Corporate Director |
Jul 21, 2014 | |
| Betty Worthy |
Corporate Director |
Sep 26, 2018 | |
| Theresa Matthews |
Corporate Director | Jul 21, 2014 | |
| Ralph Luther Bentley |
Corporate Director |
Jul 1, 2021 | |
| Robert Jones |
Corporate Director |
Jul 21, 2014 | |
| Jennifer Foster McCracken |
Corporate Director | Jul 24, 2019 | |
| Robert Spencer |
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 |
Corporate Director |
Nov 28, 2018 | |
| Ami Robinson Steele |
Corporate Director |
Oct 8, 2022 | |
| Douglas Scarborough |
Corporate Director |
Oct 26, 2022 | |
| Brian McGinnis |
Corporate Director |
Jul 21, 2014 | |
| Ronald Worley |
Corporate Director |
Nov 28, 2018 | |
| Kristin Hayes Monza |
Corporate Director |
Oct 8, 2022 | |
| Michele Knapp |
Corporate Director |
May 26, 2021 | |
| Paula Ratchford Black |
Corporate Director |
Feb 25, 2021 | |
| Phillip Lee Hinely |
Corporate Director |
Jul 21, 2014 | |
| Ramona Neal |
Corporate Director |
Jul 21, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221109003370 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 5496733925 | Practice locations: Newton, NC |
National Provider Directory
- Tax ID family
- Gaston Family Health SE
- 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
3431 Plateau Rd
Newton, NC 28658-8809
Mailing address
200 E 2ND Ave
Gastonia, NC 28052-4358
Other names
- Kintegra at Jacob's Fork Middle
Other providers in Newton, NC
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- Jessica Lee Gendernalik
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All providers in Newton, 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 Jun 27, 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.