Lone Star Circle of Care
Organization Active NPI Federally Qualified Health Center (FQHC) · Bastrop, TX
NPI 1306236187 · NPPES record last updated May 12, 2025
Key facts
- NPI
- 1306236187
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LONE STAR CIRCLE OF CARE
- Practice address
- 605 Old Austin Hwy
Bastrop, TX 78602-5034 - Phone
- (877) 800-5722
- NPI assigned
- Jan 30, 2015
- Organization subpart
- No
Authorized official
- Name
- Jonathan David Calvin
- Title
- Ceo
- Phone
- (512) 994-1933
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 39
Other NPIs with the same Medicare PAC ID 22
Corporate family (same tax ID) 33
Practitioners 36
-
Prakash Samuel Eapen, M.D.
-
Justin Feeney, D.O.
-
Benjamin Paul Fiedler, M.D.
-
Crystal Kelly, MD
-
Tamika Latta, MD
-
Marva L Lawson, MD
-
Bernard A. Lynch, M.D.
-
Andrew Glenn Mahaffey, M.D.
-
Adeyoyin O Okunade, M.D.
-
Rachel Pantoja, M.D.
-
Dorothea Pitikas, LCSW
-
Avinash Ravipati, MD
-
Beth L Thai, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 741883
- Legal name
- LONE STAR CIRCLE OF CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 12, 2015
- Last certification
- Mar 12, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Apr 2, 2001 in TX
- Enrollment address
- 605 Old Austin Hwy
Bastrop, TX 78602-5034
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Sasha Bulkley |
Corporate Director |
Dec 1, 2023 | |
| Lindsey Tippit |
Corporate Officer |
Mar 1, 2019 | |
| Nichole J Cook |
Corporate Officer |
Aug 5, 2024 | |
| Jo Carcedo |
Corporate Director |
Dec 1, 2024 | |
| Jack G Hunnicutt |
Corporate Director |
May 13, 2004 | |
| Marc Scott Alarcon |
Corporate Director |
Feb 19, 2009 | |
| Alton McCallum |
Corporate Director |
Jan 1, 2021 | |
| Steve Pena |
Corporate Director |
Jan 1, 2015 | |
| Elizabeth Johnson |
Corporate Director |
Jan 1, 2013 | |
| Rudolph Metayer |
Corporate Director |
Jan 1, 2017 | |
| Kathleen V Butler |
W-2 Managing Employee |
Jun 1, 2014 | |
| Roland Valle |
Corporate Director |
Jan 1, 2013 | |
| Mark Schroeder |
Corporate Director |
Jan 1, 2017 | |
| John Gustainis |
Corporate Director |
Jan 1, 2005 | |
| Jonathan D Calvin |
Corporate Officer |
Dec 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20150313000918 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 5193709392 | Practice locations: Bastrop, TX |
National Provider Directory
- Tax ID family
- Lone Star Circle of Care
Locations
605 Old Austin Hwy
#340B556100
Bastrop, TX 78602
605 Old Austin Hwy
Bastrop, TX 78602
Phone (512) 308-6894
2423 Williams Dr
Ste 103
Georgetown, TX 78628
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
605 Old Austin Hwy
Bastrop, TX 78602-5034
Mailing address
2423 Williams Dr Ste 107
Georgetown, TX 78628-3269
Phone (877) 800-5722
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3439028-01 | Medicaid | TX | |
| 74-1883 | Other | MEDICARE PTAN |
Other names
- Lone Star Circle of Care at Bastrop
Other providers in Bastrop, TX
- Arthur Henry Litteken II
- Chung-Chieh Lo
- Lock,S Drug Store at Bastrop,Inc
- Logopedist, LLC
- Ashley Lombardi
- Lone Star Emergency Associates, LLC
- Lone Star House Call Physicians, LLC
- Liliana Lopez
- Pamela Nicole Lopez
- Sylvia Ibarra Lopez
All providers in Bastrop, TX · Federally Qualified Health Center (FQHC) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.