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 Ellis Middle

Practice address

144 William Ellis Dr
Advance, NC 27006-7990

Phone

(336) 998-2007

NPI assigned

Aug 21, 2020

Last updated

Aug 21, 2020By the provider in NPPES

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

Business Services Administrator

Phone

(704) 874-1907

Specialties & licenses 1

Addresses

Other names 1

• Kintegra at William Ellis Middle Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245842178. Details of each certification follow.

• CCN 341166 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 341166

Legal name

GASTON FAMILY HEALTH SERVICES INC

Doing business as

KINTEGRA AT WILLIAM ELLIS MIDDLE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 15, 2020

Last certification

Oct 15, 2020

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Jun 28, 1991 in NC

Enrollment address

144 William Ellis Dr
Advance, NC 27006-7990

Part of

Gaston Family Health SVCS

Locations

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.

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michala Chandler Washburn Davis, LCSWA, LCASR

  • Clinical Social Worker
  • Advance, NC
  • NPI 1245848043
  NPD

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

{
    "created_epoch": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1245842178",
    "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",
            "telephone_number": "704-874-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 WILLIAM ELLIS DR",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270067990",
            "telephone_number": "336-998-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2020-08-21",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINESS SERVICES 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 at William Ellis Middle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gemekia Coleman Futrell, FNP
• Allison Peddycord Gallardo, PTA
• Gaston Family Health Services, Inc. (Kintegra at Shady Grove Elementary)
• Heather L Gladd, MS., CCC-SLP
• Amanda Janel Goad, NP
• Carol Derosa Grabow, PA-C
• Kathy Lynn Gross, M.D.
• Chad Richard Hall, LPTA

• Federally Qualified Health Center (FQHC) in Advance, NC
• Providers in Advance, 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 Aug 21, 2020; 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.