NPIMap

Organization Active NPI

Lone Star Circle of Care

Doing business as Georgetown Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Georgetown, TX
National Provider Identifier
1750331963
Registry record updated Mar 3, 2011
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
Georgetown Community Clinic
Practice address
701 E University Ave
Georgetown, TX 78626-7035
Phone
(512) 863-8208
Fax
(512) 864-7238
NPI assigned
May 10, 2006
Last updated
Mar 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2011

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

Authorized official

Name
Mr. Peter C Perialas Jr.
Title
Ceo
Phone
(512) 868-1124

Specialties & licenses 1

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

Addresses

Primary practice location

701 E University Ave
Georgetown, TX 78626-7035

Mailing address

205 E University Ave
Suite 200
Georgetown, TX 78626-6814
Phone (512) 868-1124

Other identifiers 1

IdentifierTypeStateIssuer
1560575-05MedicaidTX

Other names 1

  • Georgetown Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750331963. Details of each certification follow.

  • CCN 451979 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 451979

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GEORGETOWN COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 15, 2004
Last certification
Sep 15, 2004
Ownership / control type
For profit – partnership
Facility address
701 East University Avenue
Georgetown, TX 78626

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

Locations

205 E University Ave
Ste 200
Georgetown, TX 78626
Phone (512) 686-0207

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1750331963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E UNIVERSITY AVE",
            "address_2": "SUITE 200",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786266814",
            "telephone_number": "512-868-1124",
            "fax_number": "512-868-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E UNIVERSITY AVE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267035",
            "telephone_number": "512-863-8208",
            "fax_number": "512-864-7238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE STAR CIRCLE OF CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "PERIALAS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-868-1124",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "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": "1560575-05",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgetown Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.