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 - Mocksville

Practice address

100 Ridgeview Dr
Mocksville, NC 27028-2020

Phone

(336) 477-2744

Fax

(704) 671-1404

NPI assigned

Jan 13, 2020

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 - Mocksville Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 341136

Legal name

KINTEGRA FAMILY DENTISTRY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 15, 2020

Last certification

Mar 15, 2020

Ownership / control type

For profit – partnership

Facility address

100 Ridgeview Drive
Mocksville, NC 27028

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

Locations

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581984000000",
    "number": "1700426376",
    "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": "704-853-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RIDGEVIEW DR",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282020",
            "telephone_number": "336-477-2744",
            "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": "2020-01-13",
        "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 - Mocksville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Joy Fox, FNP
• Lori Fraley, PHARMD
• Jason Michael Frost, LCMHC-A, LCAS-A
• Brittany Jordan Fryer, LCSW
• Lauren Kelty Garwood, LCMHC
• 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.

• Federally Qualified Health Center (FQHC) in Mocksville, NC
• Providers in Mocksville, 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.