Gaston Family Medicine, P. a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

32655 Issued in NC

Legal business name

GASTON FAMILY MEDICINE, P. A.

Practice address

3845 South New Hope Road
Gastonia, NC 28056-8439

Phone

(704) 824-9119

Fax

(704) 824-2401

NPI assigned

Feb 22, 2008

Last updated

Jul 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth David Burgess, M. D.NPI 1538147376

Title

Owner/ President

Phone

(704) 824-9119

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Kenneth D. Burgess, M. D. Other name

Locations

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.

• Kenneth David Burgess, M. D.

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1538147376
  NPD Authorized official

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

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1992974042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551178",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280551178",
            "telephone_number": "704-824-9119",
            "fax_number": "704-824-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3845 SOUTH NEW HOPE ROAD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280568439",
            "telephone_number": "704-824-9119",
            "fax_number": "704-824-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY MEDICINE, P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-22",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "704-824-9119",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "32655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "19982",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8919982",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "P00297412",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenneth D. Burgess, M. D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Gaston Family Health Services, Inc. (GFHS at CaroMont Women's Health - Summit)
• Gaston Family Practice PLLC
• Gaston Foot & Ankle Associates P a
• Gaston Gastroenterology, PA
• Gaston Hematology & Oncology Associates, PC
• Gaston Home Medical

• Family Medicine Physician in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.