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

GFHS WSPA Wellness Center
Kintegra/SHA at Winston-Salem Prep Academy

Practice address

1215 N. Cameron Ave.
Winston-Salem, NC 27101-1816

Phone

(336) 703-6737

Fax

(336) 713-7183

NPI assigned

Aug 18, 2008

Last updated

Jan 15, 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

Mrs. Sharmila Anderson

Title

Business Services Administrator

Phone

(704) 874-1907

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 2

• GFHS WSPA Wellness Center Doing business as
• Kintegra/SHA at Winston-Salem Prep 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 1487800892. Details of each certification follow.

• CCN 341066 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 341066

Legal name

GASTON FAMILY HEALTH SERVICES INC

Doing business as

KINTEGRA/SHA AT WINSTON-SALEM PREP ACADEMY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 10, 2017

Last certification

Mar 10, 2017

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 28, 1991 in NC

Enrollment address

1215 N Cameron Ave
Winston Salem, NC 27101-1816

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": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1487800892",
    "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": "704-874-1904",
            "fax_number": "704-874-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N. CAMERON AVE.",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271011816",
            "telephone_number": "336-703-6737",
            "fax_number": "336-713-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC",
        "enumeration_date": "2008-08-18",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_title_or_position": "BUSINESS SERVICES ADMINISTRATOR",
        "authorized_official_telephone_number": "704-874-1907",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005803",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GFHS WSPA Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kintegra/SHA at Winston-Salem Prep Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gaston Family Health Services, Inc (Kintegra/SHA at Konnoak Elementary)
• Gaston Family Health Services, Inc. (Kintegra at Flat Rock Middle)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Petree Elementary)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Mineral Springs)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Forest Park Elementary)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Carver High)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Ashley Wellness Center)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Hanes Magnet)
• Gaston Family Health Services, Inc. (Kintegra/SHA at Parkland High)
• Gaston Family Health Services, Inc. (Kintegra at Kimmel Farm Elementary)

• Federally Qualified Health Center (FQHC) in Winston Salem, NC
• Providers in Winston Salem, 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 Jan 15, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.