NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as Catawba Valley Family Medicine - Northeast Hickory

  • Federally Qualified Health Center (FQHC)
  • Hickory, NC
National Provider Identifier
1407133069
Registry record updated May 7, 2021
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.
Doing business as
Catawba Valley Family Medicine - Northeast Hickory
Practice address
2365 Springs Rd NE
Hickory, NC 28601-3067
Phone
(828) 256-2112
Fax
(828) 256-2393
NPI assigned
Nov 10, 2011
Last updated
May 7, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CATAWBA VALLEY MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Authorized official

Name
Mr. Robert Ervin Spencer
Title
Ceo
Phone
(704) 874-1902

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

2365 Springs Rd NE
Hickory, NC 28601-3067

Mailing address

200 E 2ND Ave
Gastonia, NC 28052
Phone (704) 874-1904

Other identifiers 1

IdentifierTypeStateIssuer
1407133069MedicaidNC

Other names 1

  • Catawba Valley Family Medicine - Northeast Hickory Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120420000030 NC Part B Supplier - Clinic/Group Practice 6305007279 Receives reassigned benefits from 162 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hickory, NC; Lenoir, NC; Maiden, NC; Newton, NC; Sherrills Ford, NC; Sherrills FRD, NC; Taylorsville, NC; Claremont, NC…
O20170824000982 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Hickory, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407133069. Details of each certification follow.

Federally qualified health center certification: CCN 341071

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
CATAWBA VALLEY FAMILY MEDICINE - NORTHEAST HICKORY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2017
Last certification
Aug 24, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1991 in NC
Enrollment address
2365 Springs Rd NE
Hickory, NC 28601-3067

Other NPIs on the same Medicare enrollment 29

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

View all 29

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health SE264 organizations share this tax ID, including this one
Part of
Catawba Valley Medical Group Inc

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

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brittany Megan Bonn Individual Corporate DirectorBoard Member Jul 1, 2026
Jennifer Bennett Individual Corporate DirectorBoard Member Jul 1, 2026
Shirley Stowe Individual Corporate Director Jul 21, 2014
Laura Bradham Clark Individual Corporate DirectorBoard Member Jul 1, 2026
Harold Thornburg Individual Corporate DirectorBoard Member Sep 1, 2022
Charles Luther Moore Individual Corporate DirectorBoard Member Sep 28, 2022
John Herrera Individual Corporate DirectorBoard Member Jul 21, 2014
Thomas Daniel Williams Individual Corporate DirectorBoard Member Jul 1, 2026
Betty Worthy Individual Corporate DirectorBoard Member Sep 1, 2022
Theresa Matthews Individual Corporate DirectorBoard Member Sep 1, 2022
Stephanie Jacques Parent Individual Corporate DirectorBoard Member Jul 1, 2026
Ralph Luther Bentley Individual Corporate DirectorBoard Member Sep 1, 2022
Jennifer Foster McCracken Individual Corporate DirectorBoard Member Sep 1, 2022
Robert Spencer Individual Corporate OfficerChief Executive Officer Jan 8, 1996
Corporate Director Jan 8, 1996
W-2 Managing Employee Jan 8, 1996
Operational/Managerial Control Jan 8, 1996
James Macomson Individual Corporate DirectorBoard Member Sep 1, 2022
Douglas Scarborough Individual Corporate DirectorBoard Member Oct 26, 2022
Brian McGinnis Individual Corporate DirectorBoard Member Sep 1, 2022
Kristin Hayes Monza Individual Corporate DirectorBoard Member Apr 27, 2022
Michele Knapp Individual Corporate DirectorBoard Member Sep 1, 2022
Paula Ratchford Black Individual Corporate DirectorBoard Member Sep 1, 2022
Phillip Lee Hinely Individual Corporate DirectorBoard Member Jul 21, 2014
Molly Brown Quackenbush Individual W-2 Managing EmployeeDirector of Credentialing & Clinica Jul 1, 2026
Ramona Neal Individual Corporate DirectorBoard Member Jul 21, 2014
Wendy Martinez Individual Corporate DirectorBoard Member Jul 1, 2026

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1407133069",
    "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": "28052",
            "telephone_number": "704-874-1904",
            "fax_number": "704-874-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 SPRINGS RD NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013067",
            "telephone_number": "828-256-2112",
            "fax_number": "828-256-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATAWBA VALLEY MEDICAL GROUP, INC.",
        "enumeration_date": "2011-11-10",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ERVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-874-1902",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407133069",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catawba Valley Family Medicine - Northeast Hickory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Catawba Valley Family Medicine - Northeast Hickory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.