Lone Star Circle of Care
Organization Active NPI Family Medicine Physician · Elgin, TX
NPI 1679905640 · NPPES record last updated Aug 1, 2013
Key facts
- NPI
- 1679905640
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- P4217 (TX)
- Legal business name
- LONE STAR CIRCLE OF CARE
- Practice address
- 902 W 2ND St
Elgin, TX 78621-2515 - Phone
- (512) 626-0207
- NPI assigned
- Aug 1, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- LONE STAR CIRCLE OF CARE
Authorized official
- Name
- Mr. Pete Perialas
- Title
- Ceo
- Phone
- 51268680207
Other NPIs on the same Medicare enrollment 39
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
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… |
National Provider Directory
- Part of
- Lone Star Circle of Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 51345 | TX | |
| Family Medicine Physician |
207Q00000X | P4217 | TX | Yes |
| Family Nurse Practitioner |
363LF0000X | 816106 | TX |
Addresses
Primary practice location
902 W 2ND St
Elgin, TX 78621-2515
Mailing address
205 E University Ave
Suite 200
Georgetown, TX 78626-6814
Phone (512) 626-0207
Other names
- Lone Star Circle of Care @ Elgin
Other providers in Elgin, TX
- Yvette Elizabeth Johnson
- Rayshard Jarrell Lewis
- Life Guardian Med LLC
- Lighthouse Professional Counseling, PLLC
- Sheryl Lo
- Michelle Hanh Ma
- Donna Mabry
- Makana Path LLC
- Diane Martinez
- Ednica Maxineau
All providers in Elgin, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2013. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.