NPIMap

Organization Active NPI

Lone Star Circle of Care

Doing business as Lone Star Circle of Care at Texas A&M Health Science Center

  • Federally Qualified Health Center (FQHC)
  • Round Rock, TX
National Provider Identifier
1447586961
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
Doing business as
Lone Star Circle of Care at Texas A&M Health Science Center
Practice address
3950 N a W Grimes Blvd
Round Rock, TX 78665-3540
Phone
(877) 800-5722
Fax
(512) 868-9894
NPI assigned
Oct 19, 2009
Last updated
May 12, 2025By 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 May 12, 2025

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

Authorized official

Name
Jonathan David Calvin
Title
Ceo
Phone
(512) 994-1933

Specialties & licenses 1

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

Addresses

Primary practice location

3950 N a W Grimes Blvd
Round Rock, TX 78665-3540

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2104234-01MedicaidTX

Other names 1

  • Lone Star Circle of Care at Texas A&M Health Science Center 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…
O20100419000665 TX Part A Provider - Federally Qualified Health Center (FQHC) 5193709392 Practice locations: Round Rock, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447586961. Details of each certification follow.

Federally qualified health center certification: CCN 671941

Legal name
LONE STAR CIRCLE OF CARE
Doing business as
LONE STAR CIRCLE OF CARE AT TEXAS A&M HEALTH SCIENCE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 2010
Last certification
May 17, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 2011 in TX
Enrollment address
3950 N a W Grimes Blvd
Round Rock, TX 78665-3540

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
LSCC Georgetown Pharmacy- Williams Drive34 organizations share this tax ID, including this one
Part of
LSCC Georgetown Pharmacy- Williams Drive

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 DirectorBoard Member, Chairman Feb 1, 2003
Marc Scott Alarcon Individual Corporate DirectorBoard Member Feb 19, 2009
Alton McCallum Individual Corporate Director Jan 1, 2021
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 EmployeeChief Medical Officer Jun 1, 2014
Roland Valle Individual Corporate DirectorBoard Member Jan 27, 2011
Mark Schroeder Individual Corporate Director 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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1447586961",
    "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": "3950 N A W GRIMES BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786653540",
            "telephone_number": "877-800-5722",
            "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": "2009-10-19",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "CALVIN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "DAVID",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2104234-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Circle of Care at Texas A&M Health Science Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.