NPIMap

Organization Active NPI

Lone Star Circle of Care

Doing business as Belton Pediatric Clinic

  • Federally Qualified Health Center (FQHC)
  • Belton, TX
National Provider Identifier
1255562013
Registry record updated Mar 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LONE STAR CIRCLE OF CARE
Doing business as
Belton Pediatric Clinic
Practice address
255 Sparta Rd
Belton, TX 76513-1424
Phone
(512) 868-1124
Fax
(512) 868-9894
NPI assigned
Jul 28, 2009
Last updated
Mar 3, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
LONE STAR CIRCLE OF CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2011

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

Authorized official

Name
Mr. Peter C Perialas
Title
Ceo
Phone
(512) 868-1124

Specialties & licenses 1

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

Addresses

Primary practice location

255 Sparta Rd
Belton, TX 76513-1424

Mailing address

205 E University Ave
Suite 200
Georgetown, TX 78626-6814
Phone (512) 868-1124

Other identifiers 1

IdentifierTypeStateIssuer
2073256-01MedicaidTX

Other names 1

  • Belton Pediatric Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040622000184 TX Part B Supplier - Clinic/Group Practice 5193709392 Receives reassigned benefits from 181 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Austin, TX; Taylor, TX; Round Rock, TX; Pflugerville, TX; Killeen, TX; Jonestown, TX; Hutto, TX; Harker Heights, TX…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255562013. Details of each certification follow.

  • CCN 671935 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 671935

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
BELTON PEDIATRIC CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2010
Last certification
Feb 26, 2010
Ownership / control type
For profit – corporation
Facility address
255 Sparta Rd
Belton, TX 76513

Other NPIs on the same Medicare enrollment 39

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

View all 39

National Provider Directory

National Provider Directory
Part of
Georgetown Community Clinic

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1255562013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E UNIVERSITY AVE",
            "address_2": "SUITE 200",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786266814",
            "telephone_number": "512-868-1124",
            "fax_number": "512-868-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 SPARTA RD",
            "city": "BELTON",
            "state": "TX",
            "postal_code": "765131424",
            "telephone_number": "512-868-1124",
            "fax_number": "512-868-9894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE STAR CIRCLE OF CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONE STAR CIRCLE OF CARE",
        "enumeration_date": "2009-07-28",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "PERIALAS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-868-1124",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "2073256-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Belton Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belton, TX

Sources for this page

Verify at the official NPI Registry.