NPIMap

Organization Active NPI

Lone Star Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Willis, TX
National Provider Identifier
1013380708
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LONE STAR COMMUNITY HEALTH CENTER, INC.
Practice address
9516 FM 1097 Rd W Ste 140
Willis, TX 77318-4976
Phone
(936) 539-4004
Fax
(936) 224-4205
NPI assigned
Nov 4, 2015
Organization subpart
Yes
Parent organization
LONE STAR COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Authorized official

Name
Karen Harwell
Title
Chief Executive Officer
Phone
(936) 539-4004

Specialties & licenses 1

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

Addresses

Primary practice location

9516 FM 1097 Rd W Ste 140
Willis, TX 77318-4976

Mailing address

605 S Conroe Medical Dr
Conroe, TX 77304-4722

Other identifiers 1

IdentifierTypeStateIssuer
3526378-01MedicaidTX

Other names 1

  • Lone Star Family Health Center - Willis Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160114001594 TX Part A Provider - Federally Qualified Health Center (FQHC) 7416841994 Practice locations: Willis, TX

Federally qualified health center certification: CCN 741910

Legal name
LONE STAR COMMUNITY HEALTH CENTER, INC
Doing business as
LONE STAR FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 7, 2016
Last certification
Jan 7, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 2002 in TX
Enrollment address
9516 FM 1097 Rd W
Ste 140
Willis, TX 77318-4976

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lone Star Comm HLTH Ctr Inc7 organizations share this tax ID, including this one
Part of
Lone Star Comm HLTH Ctr Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

605 S Conroe Medical Dr
Conroe, TX 77304

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Alfredo Hassey Individual Corporate DirectorBoard of Director Feb 1, 2017
Lane J Aiena Individual Corporate DirectorBoard of Director Jul 1, 2021
Stephanie Atkins Individual Corporate OfficerSecretary Dec 30, 2022
Corporate DirectorBoard of Director Feb 1, 2022
Anthony Shelton Individual Corporate DirectorBoard of Director Sep 27, 2012
Paola Gorman Individual Corporate DirectorBoard of Director Apr 24, 2024
Ana Stella Individual Corporate DirectorBoard of Director Jan 1, 2023
Denise Cipolla Individual Corporate DirectorBoard of Director Nov 1, 2019
Rodrigo Chaves Individual Corporate DirectorBoard of Director Feb 24, 2004
Heidi Albright Individual W-2 Managing EmployeeChief Operating Officer Apr 8, 2019
Duke Coon Individual Corporate OfficerPresident Nov 1, 2020
Corporate DirectorBoard of Director Nov 1, 2008
Karen Harwell Individual Corporate OfficerVice President Feb 1, 2017
W-2 Managing EmployeeChief Executive Officer Nov 5, 2012
Hector Forestier Individual Corporate DirectorBoard of Director Nov 1, 2018
Phillip Chris Grice Individual Corporate DirectorBoard of Director Aug 1, 2023
Karen Lonon Individual Corporate DirectorBoard of Director Apr 24, 2014

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1013380708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S CONROE MEDICAL DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9516 FM 1097 RD W STE 140",
            "city": "WILLIS",
            "state": "TX",
            "postal_code": "773184976",
            "telephone_number": "936-539-4004",
            "fax_number": "936-224-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE STAR COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONE STAR COMMUNITY HEALTH CENTER, INC.",
        "enumeration_date": "2015-11-04",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "HARWELL",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "936-539-4004"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3526378-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Family Health Center - Willis",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willis, TX

Sources for this page

Verify at the official NPI Registry.