NPIMap

Organization Active NPI

Tyler Family Circle of Care

Doing business as Family Circle of Care

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
National Provider Identifier
1144575820
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TYLER FAMILY CIRCLE OF CARE
Doing business as
Family Circle of Care
Practice address
13172 State Highway 64 E
Tyler, TX 75707-5340
Phone
(903) 535-9041
NPI assigned
Jul 18, 2012
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

Name
Kristen S Harris, JD
Title
Chief Executive Officer
Phone
(903) 535-9041

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X TX Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

13172 State Highway 64 E
Tyler, TX 75707-5340

Mailing address

523 S Fannin Ave
Tyler, TX 75702-8204
Phone (903) 535-9041

Other practice location 1

214 E Houston St
Tyler, TX 75702-8131
Phone (903) 535-9041

Other practice location 2

110 E 9th St
Tyler, TX 75701-4227
Phone (903) 535-9041

Other practice location 3

510 E Commerce St
Jacksonville, TX 75766-4910
Phone (903) 535-9041

Other practice location 4

523 S Fannin Ave
Tyler, TX 75702-8204
Phone (903) 535-9041

Other practice location 5

2231 W Gentry Pkwy
Tyler, TX 75702-2809
Phone (903) 535-9041

Other practice location 6

2990 N Broadway Ave
Tyler, TX 75702-2149
Phone (903) 535-9041

Other practice location 7

1001 N Palestine St
Athens, TX 75751-4122
Phone (903) 535-9041

Other practice location 8

928 N Glenwood Blvd
Tyler, TX 75702-5055
Phone (903) 535-9041

Other names 1

  • Family Circle of Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20120911000666 TX Part B Supplier - Clinic/Group Practice 4587812888 Receives reassigned benefits from 62 practitioners
Practice locations: Athens, TX; Tyler, TX; Jacksonville, TX
O20131009001195 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Tyler, TX
O20131118001492 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Tyler, TX
O20150731016644 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Tyler, TX
O20161205000800 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Jacksonville, TX
O20170628002143 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Athens, TX
O20210602002426 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Tyler, TX
O20241024001403 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Tyler, TX
O20250625003918 TX Part A Provider - Federally Qualified Health Center (FQHC) 4587812888 Practice locations: Tyler, TX

NPI to CCN mapping 10

The Medicare certification numbers (CCNs) connected to NPI 1144575820. Details of each certification follow.

Federally qualified health center certification: CCN 741828

Legal name
TYLER FAMILY CIRCLE OF CARE
Doing business as
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 9, 2013
Last certification
Sep 9, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2011 in TX
Enrollment address
928 N Glenwood Blvd
Tyler, TX 75702-5055

Federally qualified health center certification: CCN 741829

Legal name
TYLER FAMILY CIRCLE OF CARE
Doing business as
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 15, 2013
Last certification
Nov 15, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2011 in TX
Enrollment address
2990 N Broadway Ave
Tyler, TX 75702-2149

Federally qualified health center certification: CCN 741899

Legal name
TYLER FAMILY CIRCLE OF CARE
Doing business as
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 27, 2015
Last certification
Jul 27, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2011 in TX
Enrollment address
214 E Houston St
Tyler, TX 75702-8131

Federally qualified health center certification: CCN 741940

Legal name
TYLER FAMILY CIRCLE OF CARE
Doing business as
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2016
Last certification
Dec 5, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2011 in TX
Enrollment address
510 E Commerce St
Jacksonville, TX 75766-4910

Federally qualified health center certification: CCN 741953

Legal name
TYLER FAMILY CIRCLE OF CARE
Doing business as
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 28, 2017
Last certification
Jun 28, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2011 in TX
Enrollment address
1001 N Palestine St
Athens, TX 75751-3614

Federally qualified health center certification: CCN 451154

Legal name
TYLER FAMILY CIRCLE OF CARE
Doing business as
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 9, 2021
Last certification
Aug 9, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2011 in TX
Enrollment address
2231 W Gentry Pkwy
Tyler, TX 75702-2809

Federally qualified health center certification: CCN 971026

Legal name
TYLER FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2024
Last certification
Oct 22, 2024
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
13172 State Highway 64 E
Tyler, TX 75707-5340

Federally qualified health center certification: CCN 971067

Legal name
TYLER FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 25, 2025
Last certification
Jun 25, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
523 S Fannin Ave
Tyler, TX 75702-8204

Federally qualified health center certification: CCN 671907

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
PRIMARY CARE CLINIC STD/HIV
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 8, 2009
Last certification
May 8, 2009
Ownership / control type
For profit – corporation
Facility address
928 North Glenwood Road
Tyler, TX 75702

Federally qualified health center certification: CCN 971109

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
FAMILY CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2026
Last certification
May 19, 2026
Ownership / control type
For profit – corporation
Facility address
110 E 9TH St
Tyler, TX 75701

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
45D0904294Tyler Family Circle of Care2990 North Broadway, Tyler, TX 75702Certificate of waiverJan 10, 2027
45D2117319Jacksonville Family Circle of Care510 E Commerce Street, Jacksonville, TX 75766Certificate of waiverAug 6, 2026
45D2128504Family Circle of Care-Athens1001 N Palestine Street, Athens, TX 75751Certificate of waiverJun 28, 2027
45D2227630Tyler Family Circle of Care West Gentry Clinic2231 West Gentry Parkway, Tyler, TX 75702Certificate of waiverJun 14, 2027
45D2306538Family Circle of Care Chapel Hill Clinic13172 State Hwy 64 East, Tyler, TX 75707Certificate of waiverJun 19, 2028

National Provider Directory

National Provider Directory

Locations

1001 N Palestine St
Athens, TX 75751
Phone (903) 904-5084

13172 State Highway 64 E
Tyler, TX 75707
Phone (903) 566-2311

2231 W Gentry Pkwy
Tyler, TX 75702
Phone (903) 877-7343

928 N Glenwood Blvd
Tyler, TX 75702
Phone (903) 533-7400

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Clinton Davis Individual Corporate OfficerBoard Vice President Dec 18, 2017
Corporate OfficerBoard Vice President Jun 12, 2015
Corporate OfficerBoard Vice President Dec 18, 2017 5%
Corporate OfficerBoard Vice President Apr 14, 2017
Corporate OfficerBoard Member Dec 18, 2017 5%
Josephine Katherine Porter Individual Corporate OfficerChief Medical Officer Oct 1, 2019
Corporate DirectorChief Medical Officer Oct 1, 2019
Operational/Managerial ControlChief Medical Officer Oct 1, 2019
Corporate OfficerCmo Oct 1, 2019
Corporate DirectorCmo Oct 1, 2019
Operational/Managerial ControlCmo Oct 1, 2019
Tyler Family Circle of Care Organization, Tyler, TX Corporation, Non-profit Operational/Managerial Control Jun 17, 2011 100%
Operational/Managerial Control Jun 12, 2015 100%
Operational/Managerial Control Nov 1, 2022 100%
Operational/Managerial Control Apr 14, 2017 100%
Operational/Managerial Control Jul 1, 2021 100%
Kristen S Harris Individual Corporate OfficerChief Executive Officer Mar 30, 2020 100%
Corporate OfficerCeo Jul 1, 2024 100%
Corporate OfficerCeo Mar 30, 2020 100%
Elias David Fajardo Individual W-2 Managing EmployeeCredentialing Analyst Oct 1, 2019
Linda F Isabell Individual Corporate OfficerChief Operating Officer Oct 1, 2015
W-2 Managing EmployeeChief Operating Officer Oct 1, 2015
Operational/Managerial ControlChief Operating Officer Oct 1, 2015
Corporate OfficerCoo/Delegated Official Oct 1, 2015
W-2 Managing EmployeeCoo/Delegated Official Oct 1, 2015
Operational/Managerial ControlCoo/Delegated Official Oct 1, 2015
Corporate OfficerCoo/Authorized Official Oct 1, 2015 5%
W-2 Managing EmployeeCoo/Authorized Official Oct 1, 2015 5%
Operational/Managerial ControlCoo/Authorized Official Oct 1, 2015 5%
Corporate OfficerCoo/Authorized Official Sep 1, 2016 5%
W-2 Managing EmployeeCoo/Authorized Official Sep 1, 2016 5%
Operational/Managerial ControlCoo/Authorized Official Sep 1, 2016 5%
Corporate OfficerCoo/Authorized Official Apr 14, 2017
Corporate DirectorCoo/Authorized Official Apr 14, 2017
W-2 Managing EmployeeCoo/Authorized Official Apr 14, 2017
Operational/Managerial ControlCoo/Authorized Official Apr 14, 2017
Joyce E Armstrong Scurry Individual Corporate OfficerBoard President/Chair Jun 17, 2011
Corporate OfficerBoard Member President Jun 12, 2015
Corporate OfficerBoard President Jun 17, 2011 5%
Corporate OfficerBoard President/Chair Apr 14, 2017
Corporate OfficerBoard President/Chair Jun 17, 2011 5%
Leroy Biggers Individual Corporate OfficerBoard Secretary Jun 17, 2011
Corporate OfficerBoard Member/Secretary Jun 12, 2015
Corporate OfficerBoard Secretary Jun 17, 2011 5%
Corporate OfficerBoard Secretary Apr 14, 2017
Alicia G Hall Individual W-2 Managing EmployeeProvider Enrollment Jun 17, 2024

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 78

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.

View all 78

NPI Registry JSON

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1144575820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 S FANNIN AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028204",
            "telephone_number": "903-535-9041",
            "fax_number": "903-747-8163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13172 STATE HIGHWAY 64 E",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757075340",
            "telephone_number": "903-535-9041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 E Houston St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028131",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-533-1747",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 E 9th St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757014227",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 E Commerce St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "TX",
            "postal_code": "757664910",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-586-0001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "523 S Fannin Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028204",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-747-8163",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2231 W Gentry Pkwy",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757022809",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-787-5098",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2990 N Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757022149",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-592-3886",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 N Palestine St",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "TX",
            "postal_code": "757514122",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-904-5085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "928 N Glenwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757025055",
            "country_code": "US",
            "telephone_number": "903-535-9041",
            "fax_number": "903-533-0726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TYLER FAMILY CIRCLE OF CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "903-535-9041",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Circle of Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.