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 William R. Davie Elementary

Practice address

3437 US Highway 601 N
Mocksville, NC 27028-6259

Phone

(336) 492-5421

Fax

(336) 492-2699

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 William R. Davie Elementary Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Federally qualified health center certification: CCN 861824

Legal name

GASTON FAMILY HEALTH SERVICES INC

Doing business as

KINTEGRA AT WILLIAM R. DAVIE ELEMENTARY

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

Organization structure

CorporationNon-profit

Incorporated

Jun 28, 1991 in NC

Enrollment address

3437 US Highway 601 N
Mocksville, NC 27028-6259

Part of

Gaston Family Health SE

Locations

All disclosed owners & managing parties 22

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 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

  Corporate Director

  CMS ownership
• Kristin Hayes Monza, NP

  • Nurse Practitioner
  • Charlotte, NC
  • NPI 1437692035

  Corporate Director

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brittani Elaine Wilson, LCSW

  • Clinical Social Worker
  • Mocksville, NC
  • NPI 1073860326
  NPD
• Regina Elizabeth Youmans, LCSWA

  • Clinical Social Worker
  • Winston Salem, NC
  • NPI 1073247219
  NPD
• Lura Katherine Joiner

  • Clinical Social Worker
  • High Point, NC
  • NPI 1487182382
  NPD (past)

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": "1215508585",
    "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": "3437 US HIGHWAY 601 N",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270286259",
            "telephone_number": "336-492-5421",
            "fax_number": "336-492-2699"
        }
    ],
    "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 William R. Davie Elementary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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.
• 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.