NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as PACE of the Southern Piedmont

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
National Provider Identifier
1912522020
Registry record updated Jun 15, 2020
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
PACE of the Southern Piedmont
Practice address
6133 The PLZ
Charlotte, NC 28215-2401
Phone
(704) 887-3840
Fax
(704) 887-3844
NPI assigned
Jun 15, 2020
Last updated
Jun 15, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Authorized official

Name
Sharmila Alexander Anderson
Title
Business Services Administrator
Phone
(704) 874-1907

Specialties & licenses 1

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

Addresses

Primary practice location

6133 The PLZ
Charlotte, NC 28215-2401

Mailing address

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

Other names 1

  • PACE of the Southern Piedmont Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250502002839 NC Part B Supplier - Pharmacy 5496733925 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lexington, NC; Statesville, NC; Shelby, NC; Lincolnton, NC; Kings Mountain, NC; Gastonia, NC; Asheboro, NC; Charlotte, NC…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912522020. Details of each certification follow.

  • CCN 341158 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 341158

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PACE OF THE SOUTHERN PIEDMONT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 7, 2020
Last certification
Jul 7, 2020
Ownership / control type
For profit – partnership
Facility address
6133 The PLZ
Charlotte, NC 28215

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Part of
Gaston Family Health Ser

Locations

6133 The Plaza
Charlotte, NC 28215
Phone (704) 887-3840

NPI Registry JSON

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1912522020",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6133 THE PLZ",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282152401",
            "telephone_number": "704-887-3840",
            "fax_number": "704-887-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2020-06-15",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINESS SERVICES 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": "PACE of the Southern Piedmont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.