NPIMap

Organization Active NPI

Lone Star Circle of Care

  • Federally Qualified Health Center (FQHC)
  • Killeen, TX
National Provider Identifier
1376840140
Registry record updated May 12, 2025
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
Practice address
2300 S Clear Creek Rd
Suite 105
Killeen, TX 76549-4985
Phone
(877) 800-5722
Fax
(254) 554-3741
NPI assigned
Feb 14, 2011
Organization subpart
Yes
Parent organization
LONE STAR CIRCLE OF CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Authorized official

Name
Jon Calvin
Title
Ceo
Phone
(512) 994-1933

Specialties & licenses 1

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

Addresses

Primary practice location

2300 S Clear Creek Rd
Suite 105
Killeen, TX 76549-4985

Mailing address

2423 Williams Dr Ste 107
Georgetown, TX 78628-3269
Phone (877) 800-5722

Other identifiers 1

IdentifierTypeStateIssuer
2186900-02MedicaidTX

Other names 1

  • Lone Star Circle of Care at Killeen Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

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…
O20110406000988 TX Part A Provider - Federally Qualified Health Center (FQHC) 5193709392 Practice locations: Killeen, TX

Federally qualified health center certification: CCN 671967

Legal name
LONE STAR CIRCLE OF CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 4, 2011
Last certification
May 4, 2011
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Apr 12, 2001 in TX
Enrollment address
2300 Clear Creek Rd
Ste 105
Killeen, TX 76549-4985

Other NPIs with the same Medicare PAC ID 22

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

View all 22

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
Tax ID family
Lone Star Circle of Care34 organizations share this tax ID, including this one
Part of
Lone Star Circle of Care

Other organizations with this tax ID 33

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

View all 33

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Sasha Bulkley Individual Corporate DirectorBoard Member Dec 1, 2023
Lindsey Tippit Individual Corporate OfficerCoo Mar 1, 2019
Nichole J Cook Individual Corporate OfficerCfo Aug 5, 2024
Jo Carcedo Individual Corporate DirectorBoard Member Dec 1, 2024
Jack G Hunnicutt Individual Corporate DirectorChairman of the Board of Directors Feb 1, 2003
Marc Scott Alarcon Individual Corporate DirectorBoard Member Feb 12, 2009
Alton McCallum Individual Corporate DirectorBoard Member Jan 1, 2020
Steve Pena Individual Corporate DirectorBoard Member Jan 1, 2015
Elizabeth Johnson Individual Corporate DirectorBoard Member Jan 1, 2013
Rudolph Metayer Individual Corporate DirectorBoard Member Jan 1, 2017
Kathleen V Butler Individual Corporate OfficerCmo Jun 1, 2014
W-2 Managing EmployeeCmo Jun 1, 2014
Roland Valle Individual Corporate DirectorBoard Member Jan 1, 2013
Mark Schroeder Individual Corporate DirectorBoard Member Jan 1, 2017
John Gustainis Individual Corporate DirectorBoard Member Jan 1, 2005
Jonathan D Calvin Individual Corporate OfficerCeo Dec 1, 2020

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1376840140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 WILLIAMS DR STE 107",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283269",
            "telephone_number": "877-800-5722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 S CLEAR CREEK RD",
            "address_2": "SUITE 105",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765494985",
            "telephone_number": "877-800-5722",
            "fax_number": "254-554-3741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE STAR CIRCLE OF CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONE STAR CIRCLE OF CARE",
        "enumeration_date": "2011-02-14",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "CALVIN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-994-1933"
    },
    "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": "2186900-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Circle of Care at Killeen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.