NPIMap

Organization Active NPI

Lone Star Circle of Care

Doing business as Lone Star Circle of Care at Georgetown Dental

  • Federally Qualified Health Center (FQHC)
  • Georgetown, TX
National Provider Identifier
1639129331
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 Georgetown Dental
Practice address
2411 Williams Dr
Suite 111
Georgetown, TX 78628-3271
Phone
(877) 800-5722
Fax
(512) 864-1447
NPI assigned
May 11, 2006
Last updated
May 12, 2025By the provider in NPPES
Organization subpart
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
General Practice Dentistry 1223G0001X

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 1

IdentifierTypeStateIssuer
1560575-03MedicaidTX

Other names 1

  • Lone Star Circle of Care at Georgetown Dental 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…
O20241122004161 TX Part A Provider - Federally Qualified Health Center (FQHC) 5193709392 Practice locations: Georgetown, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639129331. Details of each certification follow.

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
OtherNon-profit
Incorporated
Apr 21, 2001 in TX
Enrollment address
2411 Williams Dr
Ste 111
Georgetown, TX 78628-3268

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

Other organizations with this tax ID 33

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

View all 33

Locations

11111 Research Blvd
Ste 230
Austin, TX 78759
Phone (512) 795-4620

11111 Research Blvd
Ste 310
Austin, TX 78759
Phone (512) 476-9149

1221 W Ben White Blvd
Ste 200B
Austin, TX 78704
Phone (512) 524-9249

1221 W Ben White Blvd
Ste B300
Austin, TX 78704
Phone (512) 524-9293

1600 W 38th St
Ste 212
Austin, TX 78731
Phone (512) 324-3315

5339 N Interstate 35
Austin, TX 78723

6937 N Interstate 35
Ste 2
Austin, TX 78752

8913 Collinfield Dr
Unit 1
Austin, TX 78758
Phone (512) 982-6954

205 Sparta Rd
Belton, TX 76513

901 Cypress Creek Rd
Ste 102
Cedar Park, TX 78613
Phone (512) 551-5590

2423 Williams Dr
Ste 103
Georgetown, TX 78628

2423 Williams Dr
Ste 105
Georgetown, TX 78628

2423 Williams Dr
Ste 108
Georgetown, TX 78628
Phone (512) 686-0383

123 Ed Schmidt Blvd
Ste 140
Hutto, TX 78634
Phone (806) 786-2795

2300 Clear Creek Rd
Ste 105
Killeen, TX 76549
Phone (254) 554-3494

2120 N Mays St
Ste 490
Round Rock, TX 78664
Phone (512) 341-8908

2300 Round Rock Ave
Ste 208
Round Rock, TX 78681
Phone (512) 218-1222

3950 N A W Grimes Blvd
Ste 104
Round Rock, TX 78665

3950 N A W Grimes Blvd
Ste 202
Round Rock, TX 78665

3950 N A W Grimes Blvd
Ste N102
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 N202
Round Rock, TX 78665

600 S 25th St
Temple, TX 76504
Phone (254) 771-8200

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 OfficerChief Operations Officer Mar 1, 2019
Nichole J Cook Individual Corporate OfficerChief Financial Officer Aug 5, 2024
Jo Carcedo Individual Corporate DirectorBoard Member Dec 1, 2024
Jack G Hunnicutt Individual Corporate DirectorBoard Member Feb 1, 2003
Marc Scott Alarcon Individual Corporate DirectorBoard Member Feb 19, 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 Dec 1, 2012
Rudolph Metayer Individual Corporate DirectorBoard Member Jan 1, 2017
Kathleen V Butler Individual Corporate OfficerChief Medical Officer 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 DirectorBoard Member Jan 1, 2017
John Gustainis Individual Corporate DirectorBoard Member Jan 1, 2005
Jonathan D Calvin Individual Corporate OfficerChief Executive Officer 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 157

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.

View all 157

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1639129331",
    "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": "2411 WILLIAMS DR",
            "address_2": "SUITE 111",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283271",
            "telephone_number": "877-800-5722",
            "fax_number": "512-864-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE STAR CIRCLE OF CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1560575-03",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Circle of Care at Georgetown Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.