NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as Kintegra Pediatric Medicine - Statesville

  • Federally Qualified Health Center (FQHC)
  • Statesville, NC
National Provider Identifier
1710237367
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
Kintegra Pediatric Medicine - Statesville
Practice address
518 Brookdale Dr
Statesville, NC 28677-4108
Phone
(704) 872-9595
Fax
(704) 872-5851
NPI assigned
Sep 11, 2012
Last updated
May 7, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES, INCAs 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
Sharmila Anderson
Title
Business Service Administrator
Phone
(704) 874-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

518 Brookdale Dr
Statesville, NC 28677-4108

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1904

Other names 1

  • Kintegra Pediatric Medicine - Statesville Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20121114000454 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Statesville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710237367. Details of each certification follow.

Federally qualified health center certification: CCN 341001

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
KINTEGRA PEDIATRIC MEDICINE - STATESVILLE
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1989 in NC
Enrollment address
518 Brookdale Dr
Statesville, NC 28677-4108

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0701976Kintegra Pediatric Medicine - Statesville518 Brookdale Drive, Statesville, NC 28677Certificate of waiverJul 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health SVCS264 organizations share this tax ID, including this one
Part of
Gaston Family Health SVCS

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 DirectorBoard Member Oct 1, 2004
Laura Bradham Clark Individual Corporate DirectorBoard Member Jul 1, 2026
Harold Thornburg Individual Corporate DirectorBoard Member May 1, 2022
Charles Luther Moore Individual Corporate DirectorBoard Member Sep 28, 2022
John Herrera Individual Corporate DirectorBoard Member May 21, 2015
Thomas Daniel Williams Individual Corporate DirectorBoard Member Jul 1, 2026
Betty Worthy Individual Corporate DirectorBoard Member May 1, 2022
Theresa Matthews Individual Corporate DirectorBoard Member May 21, 2015
Stephanie Jacques Parent Individual Corporate DirectorBoard Member Jul 1, 2026
Ralph Luther Bentley Individual Corporate DirectorBoard Member May 1, 2022
Jennifer Foster McCracken Individual Corporate DirectorBoard Member May 1, 2022
Robert Spencer Individual Corporate OfficerCeo 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 May 1, 2022
Douglas Scarborough Individual Corporate DirectorBoard Member Oct 26, 2022
Brian McGinnis Individual Corporate DirectorBoard Member May 1, 2022
Kristin Hayes Monza Individual Corporate DirectorBoard Member Apr 27, 2022
Michele Knapp Individual Corporate DirectorBoard Member May 1, 2022
Paula Ratchford Black Individual Corporate DirectorBoard Member May 1, 2022
Phillip Lee Hinely Individual Corporate DirectorBoard Member May 1, 2022
Molly Brown Quackenbush Individual W-2 Managing EmployeeDirector of Credentialing & Clinica Jul 1, 2026
Ramona Neal Individual Corporate DirectorBoard Member May 1, 2022
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": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1710237367",
    "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": "704-867-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774108",
            "telephone_number": "704-872-9595",
            "fax_number": "704-872-5851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC",
        "enumeration_date": "2012-09-11",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "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 Pediatric Medicine - Statesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.