NPIMap

Organization Active NPI

Gaston Family Health Services, Inc

Doing business as Iredell Psychiatry

  • Federally Qualified Health Center (FQHC)
  • Statesville, NC
National Provider Identifier
1912547415
Registry record updated May 9, 2025
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
Iredell Psychiatry
Practice address
766 Hartness Rd
Statesville, NC 28677-3425
Phone
(704) 380-3620
Fax
(704) 380-3623
NPI assigned
Jan 13, 2020
Last updated
May 9, 2025By 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 9, 2025

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

Authorized official

Name
Sharmila Alexander Anderson
Title
Collaboration Manager
Phone
(704) 874-1907

Specialties & licenses 1

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

Addresses

Primary practice location

766 Hartness Rd
Statesville, NC 28677-3425

Mailing address

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

Other practice location 1

515 Brookdale Dr
Statesville, NC 28677-4107
Phone (704) 883-8660

Other names 1

  • Iredell Psychiatry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200329000510 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 1912547415. Details of each certification follow.

Federally qualified health center certification: CCN 341135

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
IREDELL PSYCHIATRY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 29, 2020
Last certification
Mar 29, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1991 in NC
Enrollment address
515 Brookdale Dr
Statesville, NC 28677-4107

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health SE264 organizations share this tax ID, including this one
Part of
Gaston Family Health SE

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 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jennifer Bennett Individual Corporate DirectorBoard Member Oct 1, 2025
Shirley Stowe Individual Corporate Director Jul 21, 2014
Laura Bradham Clark Individual Corporate DirectorBoard Member Oct 1, 2025
Harold Thornburg Individual Corporate Director Jan 23, 2019
Sharmila Anderson Individual W-2 Managing Employee Jul 2, 2012
Charles Luther Moore Individual Corporate DirectorBoard Member Oct 8, 2022
Nicole Parker Waters Individual Corporate DirectorBoard Member Oct 1, 2025
John Herrera Individual Corporate Director Jul 21, 2014
Thomas Daniel Williams Individual Corporate DirectorBoard Member Oct 1, 2025
Betty Worthy Individual Corporate Director Sep 26, 2018
Theresa Matthews Individual Corporate Director Jul 21, 2014
Stephanie Jacques Parent Individual Corporate DirectorBoard Member Oct 1, 2025
Ralph Luther Bentley Individual Corporate DirectorBoard Member Oct 8, 2022
Jennifer Foster McCracken Individual Corporate Director Jul 24, 2019
Robert Spencer Individual Corporate OfficerCeo Jan 8, 1996
Corporate DirectorCeo Jan 8, 1996
W-2 Managing Employee Jan 8, 1996
Operational/Managerial Control Jan 8, 1996
James Macomson Individual Corporate Director Jul 21, 2014
Douglas Scarborough Individual Corporate DirectorBoard Member Oct 8, 2022
Brian McGinnis Individual Corporate Director Jul 21, 2014
Kristin Hayes Monza Individual Corporate DirectorBoard Member Oct 8, 2022
Michele Knapp Individual Corporate DirectorBoard Member Oct 8, 2022
Paula Ratchford Black Individual Corporate DirectorBoard Member Oct 8, 2022
Phillip Lee Hinely Individual Corporate Director Jul 21, 2014
Ramona Neal Individual Corporate Director Jul 21, 2014

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1912547415",
    "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": "704-864-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 HARTNESS RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773425",
            "telephone_number": "704-380-3620",
            "fax_number": "704-380-3623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Brookdale Dr",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286774107",
            "country_code": "US",
            "telephone_number": "704-883-8660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "COLLABORATION MANAGER",
        "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": "Iredell Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iredell Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.