Gaston Family Health Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

GASTON FAMILY HEALTH SERVICES, INC.

Practice address

1211 Salisbury Rd
Mocksville, NC 27028-9302

Phone

(336) 753-0888

Fax

(336) 753-1192

NPI assigned

Jul 7, 2021

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

Medical Billing & Coding Supervisor

Phone

(704) 874-1907

Specialties & licenses 1

Addresses

Other names 1

• Kintegra at Davie County Early College Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Federally qualified health center certification: CCN 861832

Legal name

GASTON FAMILY HEALTH SERVICES INC

Doing business as

KINTEGRA AT DAVIE COUNTY EARLY COLLEGE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 7, 2021

Last certification

Oct 7, 2021

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 28, 1991 in NC

Enrollment address

1211 Salisbury Rd
Mocksville, NC 27028-9302

Part of

Gaston Family Health SE

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

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625616000000",
    "number": "1467023747",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 SALISBURY RD",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270289302",
            "telephone_number": "336-753-0888",
            "fax_number": "336-753-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2021-07-07",
        "last_updated": "2021-07-07",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "MEDICAL BILLING & CODING SUPERVISOR",
        "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 Davie County Early College",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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.
• Ashley J Golds, LPC
• Brittney Elizabeth Grimes, NP
• Carol Elaine Gunden, FNP

• All providers in Mocksville, NC
• 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 Jul 7, 2021; 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.