Lone Star Circle of Care
Organization Active NPI Federally Qualified Health Center (FQHC) · Georgetown, TX
NPI 1639129331 · NPPES record last updated May 12, 2025
Key facts
- NPI
- 1639129331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LONE STAR CIRCLE OF CARE
- Practice address
- 2411 Williams Dr
Suite 111
Georgetown, TX 78628-3271 - Phone
- (877) 800-5722
- Fax
- (512) 864-1447
- NPI assigned
- May 11, 2006
- 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 161
-
Beth L Thai, MD
-
Helio Zapata, MD
-
Justin Feeney, D.O.
-
Benjamin Paul Fiedler, M.D.
-
Tamika Latta, 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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 971038
- Legal name
- LONE STAR CIRCLE OF CARE
- Doing business as
- LONE STAR CIRCLE OF CARE AT GEORGETOWN DENTAL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 18, 2024
- Last certification
- Nov 18, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Apr 21, 2001 in TX
- Enrollment address
- 2411 Williams Dr
Ste 111
Georgetown, TX 78628-3268
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 |
Feb 1, 2003 | |
| Marc Scott Alarcon |
Corporate Director |
Feb 19, 2009 | |
| Alton McCallum |
Corporate Director |
Jan 1, 2020 | |
| Steve Pena |
Corporate Director |
Jan 1, 2015 | |
| Elizabeth Johnson |
Corporate Director |
Dec 1, 2012 | |
| Rudolph Metayer |
Corporate Director |
Jan 1, 2017 | |
| Kathleen V Butler |
Corporate Officer |
Jun 1, 2014 | |
| W-2 Managing Employee |
Jun 1, 2014 | ||
| Roland Valle |
Corporate Director |
Jan 27, 2011 | |
| 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… |
| O20241122004161 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 5193709392 | Practice locations: Georgetown, TX |
National Provider Directory
- Tax ID family
- Lone Star Circle of Care
Locations
1221 W Ben White Blvd
Ste B100B200
Austin, TX 78704
5339 N Interstate 35
Austin, TX 78723
11111 Research Blvd
Ste 310
Austin, TX 78759
Phone (512) 476-9149
11111 Research Blvd
Ste 230
Austin, TX 78759
Phone (512) 795-4620
1221 W Ben White Blvd
Ste B300
Austin, TX 78704
Phone (512) 524-9293
205 Sparta Rd
Belton, TX 76513
901 Cypress Creek Rd
Ste 102
Cedar Park, TX 78613
Phone (512) 551-5590
2423 Williams Dr
Ste 113
Georgetown, TX 78628
Phone (512) 863-9208
2423 Williams Dr
Ste 108
Georgetown, TX 78628
Phone (512) 686-0383
775 Indian Trl
Ste 200
Harker Heights, TX 76548
Phone (254) 300-7798
1200 Binz St
Ste 270
Houston, TX 77004
Phone 8778005722 ext. 556
802 Avenue J
Marble Falls, TX 78654
Phone (830) 693-9729
2300 Round Rock Ave
Ste 208
Round Rock, TX 78681
Phone (512) 218-1222
3950 N A W Grimes Blvd
Ste 202
Round Rock, TX 78665
3950 N A W Grimes Blvd
Ste N201
Round Rock, TX 78665
Phone (512) 524-9282
3950 N A W Grimes Blvd
Ste N103
Round Rock, TX 78665
3950 N A W Grimes Blvd
Ste 104
Round Rock, TX 78665
3950 N A W Grimes Blvd
Ste N301A
Round Rock, TX 78665
Phone (512) 524-9274
1099 E Main St
Ste 200
Round Rock, TX 78664
Phone (512) 341-0500
3950 N A W Grimes Blvd
Ste N102
Round Rock, TX 78665
2120 N Mays St
Ste 490
Round Rock, TX 78664
Phone (512) 341-8908
601A Mallard Ln
Taylor, TX 76574
Phone (512) 352-3200
305 Mallard Ln
Taylor, TX 76574
Phone (512) 352-7611
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2411 Williams Dr
Suite 111
Georgetown, TX 78628-3271
Mailing address
2423 Williams Dr Ste 107
Georgetown, TX 78628-3269
Phone (877) 800-5722
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1560575-03 | Medicaid | TX |
Other names
- Lone Star Circle of Care at Georgetown Dental
Other providers in Georgetown, TX
- Jessica Theresa Loera
- Sonya Joy Londa
- Lone Star Circle of Care
- Lone Star Circle of Care
- Lone Star Circle of Care
- Lone Star Circle of Care
- Lone Star Circle of Care
- Lone Star Circle of Care
- Lone Star Circle of Care
- Lone Star Circle of Care
All providers in Georgetown, 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.