Gaston Family Health Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Asheboro, NC
NPI 1215652425 · NPPES record last updated Oct 10, 2022
Key facts
- NPI
- 1215652425
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GASTON FAMILY HEALTH SERVICES, INC.
- Practice address
- 1831 N Fayetteville St
Asheboro, NC 27203-3273 - Phone
- (336) 672-1300
- NPI assigned
- Oct 10, 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.
Other NPIs on the same Medicare enrollment 27
Corporate family (same tax ID) 24
Practitioners 1
-
Maureene Helena Andrews, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2165777 | Kintegra Family Medicine - Asheboro | Certificate of waiver | May 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NC
Federally qualified health center certification: CCN 861148
- Legal name
- GASTON FAMILY HEALTH SERVICES INC
- Doing business as
- KINTEGRA FAMILY MEDICINE - ASHEBORO
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 31, 2023
- Last certification
- May 31, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 28, 1991 in NC
- Enrollment address
- 1831 N Fayetteville St
Asheboro, NC 27203-3273
All disclosed owners & managing parties 21
| 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 | Sep 28, 2022 | |
| John Herrera |
Corporate Director | Jul 21, 2014 | |
| James Hodges |
Corporate Director | Jul 21, 2014 | |
| Theresa Matthews |
Corporate Director | Jul 21, 2014 | |
| Ralph Luther Bentley |
Corporate Director | Jul 1, 2021 | |
| Robert Jones |
Corporate Director | Nov 28, 2018 | |
| 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 | |
| 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 | Apr 27, 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 |
|---|---|---|---|---|
| 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… |
| O20230531002892 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 5496733925 | Practice locations: Asheboro, 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… |
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
1831 N Fayetteville St
Asheboro, NC 27203-3273
Mailing address
200 E 2ND Ave
Gastonia, NC 28052-4358
Other names
- Kintegra Family Medicine - Asheboro
Other providers in Asheboro, NC
- 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.
- Gaston Family Health Services, Inc.
- Gaston Family Health Services, Inc.
All providers in Asheboro, 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 Oct 10, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.