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 Central Davie Academy

Practice address

160 Martin Luther King Junior Rd
Mocksville, NC 27028

Phone

(336) 751-5712

Fax

(336) 751-5719

NPI assigned

Nov 19, 2019

Last updated

Dec 20, 2019By 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 Central Davie Academy 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 1285270868. Details of each certification follow.

• CCN 341192 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 341192

Legal name

GASTON FAMILY HEALTH SERVICES INC

Doing business as

KINTEGRA AT CENTRAL DAVIE ACADEMY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 14, 2022

Last certification

Oct 14, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 28, 1991 in NC

Enrollment address

160 Martin Luther King Jr Rd
Mocksville, NC 27028-7780

Part of

Gaston Family Health SE

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

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1285270868",
    "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": "160 MARTIN LUTHER KING JUNIOR RD",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "27028",
            "telephone_number": "336-751-5712",
            "fax_number": "336-751-5719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2019-11-19",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "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 Central Davie Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gaston Family Health Services, Inc (Kintegra Family Dentistry - Mocksville)
• Gaston Family Health Services, Inc. (Kintegra at South Davie Middle)
• Gaston Family Health Services, Inc. (Kintegra at Pinebrook Elementary)
• Gaston Family Health Services, Inc. (Kintegra at William R. Davie Elementary)
• Gaston Family Health Services, Inc. (Kintegra at Central Davie Academy)
• Gaston Family Health Services, Inc. (Kintegra at Mocksville Elementary)
• Gaston Family Health Services, Inc. (GFHS Counseling Center - Mocksville)
• Gaston Family Health Services, Inc. (Kintegra at North Davie Middle)
• Gaston Family Health Services, Inc. (Kintegra Family Medicine - Mocksville)
• Gaston Family Health Services, Inc. (Kintegra at Davie County Early College)

• 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 Dec 20, 2019; 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.