NPIMap

Organization Active NPI

Gaston Family Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Thomasville, NC
National Provider Identifier
1225445331
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GASTON FAMILY HEALTH SERVICES INC
Practice address
611 Randolph St
Thomasville, NC 27360-5126
Phone
(336) 474-4585
NPI assigned
Jul 21, 2014
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sharmila Alexander Anderson
Title
Business Service Administrator
Phone
(704) 874-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

611 Randolph St
Thomasville, NC 27360-5126

Mailing address

200 E Second Ave
Gastonia, NC 28052-4358
Phone (704) 874-1907

Other names 1

  • Kintegra Family Medicine - Thomasville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20150123000549 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Thomasville, NC

Federally qualified health center certification: CCN 341024

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
KINTEGRA FAMILY MEDICINE - THOMASVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 23, 2015
Last certification
Jan 23, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1991 in NC
Enrollment address
611 Randolph St
Thomasville, NC 27360-5126

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2110642Kintegra Family Medicine - Thomasville611 Randolph Street, Thomasville, NC 27360Certificate of waiverMar 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health SE255 organizations share this tax ID, including this one
Part of
Gaston Family Health SE

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

102 Forest Park Dr
Thomasville, NC 27360

Ownership & related parties

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.

NameRoleSinceShare
Shirley Stowe Individual Corporate Director Jul 21, 2014
Harold Thornburg Individual Corporate Director May 1, 2022
Sharmila Anderson Individual W-2 Managing EmployeeBusiness Services Administrator Jul 2, 2012
Jacobus Dodoo Individual Corporate Director May 1, 2022
John Herrera Individual Corporate Director Jul 21, 2014
James Hodges Individual Corporate Director Jul 21, 2014
Betty Worthy Individual Corporate Director May 1, 2022
Theresa Matthews Individual Corporate Director May 1, 2022
Ralph Luther Bentley Individual Corporate Director May 1, 2022
Robert Jones Individual Corporate Director May 1, 2022
Jennifer Foster McCracken Individual Corporate Director May 1, 2022
Robert Spencer Individual Corporate OfficerChief Executive Officer Jul 9, 2013
Corporate Director Jul 9, 2013
W-2 Managing Employee Jan 8, 1996
James Macomson Individual Corporate Director May 1, 2022
Brian McGinnis Individual Corporate Director May 1, 2022
Ronald Worley Individual Corporate Director May 1, 2022
Michele Knapp Individual Corporate Director May 1, 2022
Paula Ratchford Black Individual Corporate Director May 1, 2022
Phillip Lee Hinely Individual Corporate Director Jul 21, 2014
Ramona Neal Individual Corporate Director May 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1225445331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E SECOND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-1907",
            "fax_number": "704-867-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 RANDOLPH ST",
            "city": "THOMASVILLE",
            "state": "NC",
            "postal_code": "273605126",
            "telephone_number": "336-474-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES INC",
        "enumeration_date": "2014-07-21",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINESS SERVICE ADMINISTRATOR",
        "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 Family Medicine - Thomasville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thomasville, NC

Sources for this page

Verify at the official NPI Registry.