Gaston Family Health Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Shelby, NC
NPI 1366068397 · NPPES record last updated Jun 25, 2020
Key facts
- NPI
- 1366068397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GASTON FAMILY HEALTH SERVICES, INC.
- Practice address
- 305 W College Ave
Shelby, NC 28152-8111 - Phone
- (704) 818-9200
- NPI assigned
- Jun 25, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- GASTON FAMILY HEALTH SERVICES, INC.
Authorized official
- Name
- Sharmila Alexander Anderson
- Title
- Business Services Administrator
- Phone
- (704) 874-1907
Owners & managing parties with NPI records 2
-
Ralph L Bentley, M.D.
Other NPIs on the same Medicare enrollment 23
Corporate family (same tax ID) 24
Practitioners 1
-
Cindy A Pressler, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2189096 | Kintegra Family Medicine - Boiling Springs | Certificate of waiver | Jul 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341153
- Legal name
- GASTON FAMILY HEALTH SERVICES INC
- Doing business as
- KINTEGRA FAMILY MEDICINE - BOILING SPRINGS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 3, 2020
- Last certification
- Sep 3, 2020
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 28, 1991 in NC
- Enrollment address
- 305 W College Ave
Shelby, NC 28152-8111
All disclosed owners & managing parties 23
| 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 |
Oct 8, 2022 | |
| John Herrera |
Corporate Director | Jul 21, 2014 | |
| James Hodges |
Corporate Director | Jul 21, 2014 | |
| Betty Worthy |
Corporate Director | Sep 26, 2018 | |
| Theresa Matthews |
Corporate Director | Jul 21, 2014 | |
| Ralph Luther Bentley |
Corporate Director |
Oct 8, 2022 | |
| Robert Jones |
Corporate Director | Jul 21, 2014 | |
| 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 | |
| Ami Robinson Steele |
Corporate Director |
Oct 8, 2022 | |
| Douglas Scarborough |
Corporate Director |
Oct 8, 2022 | |
| Brian McGinnis |
Corporate Director | Jul 21, 2014 | |
| Ronald Worley |
Corporate Director | Nov 28, 2018 | |
| Kristin Hayes Monza |
Corporate Director |
Oct 8, 2022 | |
| Michele Knapp |
Corporate Director |
Oct 8, 2022 | |
| Paula Ratchford Black |
Corporate Director |
Oct 8, 2022 | |
| 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… |
| O20200903000897 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 5496733925 | Practice locations: Shelby, NC |
National Provider Directory
- Tax ID family
- Gaston Family Health SE
- Part of
- Gaston Family Health SE
Locations
305 W College Ave
Shelby, NC 28152
Phone (704) 434-2598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
305 W College Ave
Shelby, NC 28152-8111
Mailing address
200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1904
Other names
- Kintegra Family Medicine - Boiling Springs
Other providers in Shelby, NC
- Karen Gartner
- 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 Shelby, 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 Jun 25, 2020. 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.