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 Family Dentistry-Statesville

Practice address

518 Brookdale Dr
Statesville, NC 28677-4108

Phone

(704) 838-1108

Fax

(704) 671-1404

NPI assigned

Jan 17, 2020

Last updated

Feb 18, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

GASTON FAMILY HEALTH SERVICES, INCAs 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 Service Administrator

Phone

(704) 874-1907

Specialties & licenses 1

Addresses

Other names 1

• Kintegra Family Dentistry-Statesville Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316577406. Details of each certification follow.

• CCN 341150 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 341150

Legal name

KINTEGRA FAMILY DENTISTRY STATESVILLE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 17, 2020

Last certification

Apr 17, 2020

Ownership / control type

For profit – partnership

Facility address

518 Brookdale Drive
Statesville, NC 28677

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

CLIA laboratory certificates

Part of

Gaston Family Health SE

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

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581984000000",
    "number": "1316577406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 W HUDSON BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280526430",
            "telephone_number": "704-838-1108",
            "fax_number": "704-671-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774108",
            "telephone_number": "704-838-1108",
            "fax_number": "704-671-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "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 Dentistry-Statesville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kintegra Family Dentistry-Statesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Douglas Garrett, PA-C
• Shelby Ann Garwood, CNP
• Gary N Gaither DDS
• Gaston Family Health Services Inc (Kintegra Family Medicine - Statesville)
• Gaston Family Health Services, Inc (Kintegra Mobile Dentistry-North)
• Gaston Family Health Services, Inc (Iredell Pediatrics)
• Gaston Family Health Services, Inc (Iredell Psychiatry)
• Gaston Family Health Services, Inc. (Kintegra at Iredell County Health Dept)
• Gaston Family Health Services, Inc. (Kintegra Behavioral Health - Statesville)
• Gaston Family Health Services, Inc. (Kintegra Pediatric Medicine - Statesville)

• Federally Qualified Health Center (FQHC) in Statesville, NC
• Providers in Statesville, 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 Feb 18, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.