| Family Circle Of Care | |
|
523 S Fannin Ave Tyler TX 75702-8204 | |
| (903) 535-9041 | |
| (903) 531-9490 |
| Full Name | Family Circle Of Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 523 S Fannin Ave, Tyler, Texas |
| Authorized Official Name and Position | Kristen S Harris (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9035359041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Circle Of Care 523 S Fannin Ave Tyler TX 75702-8204 Ph: (903) 535-9041 | Family Circle Of Care 523 S Fannin Ave Tyler TX 75702-8204 Ph: (903) 535-9041 |
| NPI Number | 1144575820 |
|---|---|
| Provider Enumeration Date | 07/18/2012 |
| Last Update Date | 04/08/2023 |
| Medicare PECOS PAC ID | 4587812888 |
|---|---|
| Medicare Enrollment ID | O20120911000666 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144575820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Texas) | Primary |
| Provider Name | Mark Miles Barret |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659341055 PECOS PAC ID: 5698662278 Enrollment ID: I20040228000348 |
| Provider Name | Marel A Hanks |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306810593 PECOS PAC ID: 4385627306 Enrollment ID: I20040610001221 |
| Provider Name | Tamara L Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952439432 PECOS PAC ID: 3971579046 Enrollment ID: I20040909000602 |
| Provider Name | Toni L Richey |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265560205 PECOS PAC ID: 1254390248 Enrollment ID: I20041006000169 |
| Provider Name | Robbin Langston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295936664 PECOS PAC ID: 0547228611 Enrollment ID: I20041221000986 |
| Provider Name | Jeffrey P Smith |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760578835 PECOS PAC ID: 5294648366 Enrollment ID: I20050103000561 |
| Provider Name | Jacqueline Catney Dubois |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043206147 PECOS PAC ID: 4587689146 Enrollment ID: I20051012000813 |
| Provider Name | Stephen P Rydzak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184656555 PECOS PAC ID: 0749193811 Enrollment ID: I20060908000408 |
| Provider Name | Stephen K Patrick |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174542815 PECOS PAC ID: 6608970363 Enrollment ID: I20070406000104 |
| Provider Name | Cheryl Polkowski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194882241 PECOS PAC ID: 4385606698 Enrollment ID: I20081003000052 |
| Provider Name | Charla C Spencer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700851193 PECOS PAC ID: 5698732345 Enrollment ID: I20090422000613 |
| Provider Name | Wayne Karaki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871582924 PECOS PAC ID: 2264571710 Enrollment ID: I20091123000602 |
| Provider Name | Harold U Everett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1225002850 PECOS PAC ID: 7214078633 Enrollment ID: I20100107000536 |
| Provider Name | Amanda Lynn Harris |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336159128 PECOS PAC ID: 2264556927 Enrollment ID: I20100901000642 |
| Provider Name | Joseph L Petty |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1649461211 PECOS PAC ID: 1557486404 Enrollment ID: I20100915000587 |
| Provider Name | Jamekia T Bailey |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831418680 PECOS PAC ID: 7012100746 Enrollment ID: I20101026000467 |
| Provider Name | Rachel Ann Everson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992936603 PECOS PAC ID: 0648469148 Enrollment ID: I20110114000412 |
| Provider Name | Nicholas Paul Luzietti |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932119443 PECOS PAC ID: 6709065444 Enrollment ID: I20110126000862 |
| Provider Name | Mariellen A Speaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457336265 PECOS PAC ID: 1658557897 Enrollment ID: I20110523000847 |
| Provider Name | Anne Whitney Cates |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427348408 PECOS PAC ID: 9436327954 Enrollment ID: I20110727000283 |
| Provider Name | Judith D Sutherland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851611503 PECOS PAC ID: 6608046966 Enrollment ID: I20110824000878 |
| Provider Name | Katherine S Root |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083932818 PECOS PAC ID: 2567606445 Enrollment ID: I20130916000064 |
| Provider Name | Margaret Vidal- Kutin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275533663 PECOS PAC ID: 8224272125 Enrollment ID: I20130916000313 |
| Provider Name | Eduardo Torres |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255442653 PECOS PAC ID: 9335165075 Enrollment ID: I20131018001458 |
| Provider Name | Josephine Katherine Porter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346429677 PECOS PAC ID: 1254502511 Enrollment ID: I20140213000207 |
| Provider Name | Larry Shane Hilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720153224 PECOS PAC ID: 4385643543 Enrollment ID: I20140707000636 |
| Provider Name | Lucianne Marin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821024654 PECOS PAC ID: 4385782325 Enrollment ID: I20140801001006 |
| Provider Name | Lamesa L Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548663784 PECOS PAC ID: 8426270042 Enrollment ID: I20141117000405 |
| Provider Name | D'ann Glasco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134525561 PECOS PAC ID: 2365766102 Enrollment ID: I20150126002222 |
| Provider Name | Lell Alyne Pinkston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851797740 PECOS PAC ID: 8224353867 Enrollment ID: I20150203000208 |
| Provider Name | Amber N Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780944033 PECOS PAC ID: 2163646936 Enrollment ID: I20150602001692 |
| Provider Name | Edileola Makinde |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1811954852 PECOS PAC ID: 3476655721 Enrollment ID: I20160311001708 |
| Provider Name | Zareh H Khachikian |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215084603 PECOS PAC ID: 3971698069 Enrollment ID: I20160504002547 |
| Provider Name | Stacy R Fogle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376093278 PECOS PAC ID: 6305126616 Enrollment ID: I20161202001064 |
| Provider Name | Juan P Garrido Morales |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285073288 PECOS PAC ID: 5496054504 Enrollment ID: I20170131001527 |
| Provider Name | Khotwanaeya A Cohen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205198421 PECOS PAC ID: 0749593820 Enrollment ID: I20171017003312 |
| Provider Name | Lorena Santoro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114307790 PECOS PAC ID: 5991003485 Enrollment ID: I20180716001418 |
| Provider Name | Rabiah Zafar |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1235533027 PECOS PAC ID: 3072861830 Enrollment ID: I20180810000344 |
| Provider Name | Perla Cornelio Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780169300 PECOS PAC ID: 8022352509 Enrollment ID: I20181211000832 |
| Provider Name | Sandra J Gooding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811541923 PECOS PAC ID: 5496083503 Enrollment ID: I20190828001314 |
| Provider Name | Kristina L Reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760037790 PECOS PAC ID: 7113257379 Enrollment ID: I20191001002419 |
| Provider Name | Marissa Ann Kuykendall |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1992356588 PECOS PAC ID: 5294168860 Enrollment ID: I20191212001399 |
| Provider Name | Kimberly L Mabry-paroline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104460328 PECOS PAC ID: 4880029537 Enrollment ID: I20200127002031 |
| Provider Name | Matthew Bryan Boehme |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215460183 PECOS PAC ID: 4981026481 Enrollment ID: I20200629002115 |
| Provider Name | Kurtis G Kostan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134516172 PECOS PAC ID: 2860791886 Enrollment ID: I20200821000478 |
| Provider Name | David Rice |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902867260 PECOS PAC ID: 1456452796 Enrollment ID: I20201022004220 |
| Provider Name | Bhavani Suryadevara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710211578 PECOS PAC ID: 6002041001 Enrollment ID: I20210115001146 |
| Provider Name | Joshua Timothy Morgan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003304452 PECOS PAC ID: 4082978325 Enrollment ID: I20210512001730 |
| Provider Name | Angelica Maria Larios |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912361288 PECOS PAC ID: 8426461104 Enrollment ID: I20210513001697 |
| Provider Name | Casie May Zarate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447925821 PECOS PAC ID: 8325446719 Enrollment ID: I20211015001369 |
| Provider Name | Donna Lachelle Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114531217 PECOS PAC ID: 1355732546 Enrollment ID: I20211223000112 |
| Provider Name | Roger Pearce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295706273 PECOS PAC ID: 2961569918 Enrollment ID: I20220502000791 |
| Provider Name | Shayna Burdeaux |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386134633 PECOS PAC ID: 2860737814 Enrollment ID: I20220818003734 |
| Provider Name | Lakisha Nashun Bennings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609526771 PECOS PAC ID: 9537536743 Enrollment ID: I20221101000978 |
| Provider Name | Rachel Rene Baber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396469839 PECOS PAC ID: 5496122129 Enrollment ID: I20221109000461 |
| Provider Name | Valerie B Smith |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073625737 PECOS PAC ID: 4688045073 Enrollment ID: I20230123001325 |
| Provider Name | John D Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1720531403 PECOS PAC ID: 7012380165 Enrollment ID: I20230310001117 |
| Provider Name | Deborah Garganera Ledesma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114625670 PECOS PAC ID: 7012381635 Enrollment ID: I20230322002746 |
| Provider Name | Lailane Pancho Asuncion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306545983 PECOS PAC ID: 6204200603 Enrollment ID: I20230327001956 |
| Provider Name | Amanda Michelle Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003517244 PECOS PAC ID: 8628433745 Enrollment ID: I20230425001412 |
| Provider Name | Liliana Gelvez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205972957 PECOS PAC ID: 6204892318 Enrollment ID: I20230425003021 |
| Provider Name | Beverly S Hargrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417113523 PECOS PAC ID: 9739078668 Enrollment ID: I20230524000036 |
| Provider Name | John David Martino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285255877 PECOS PAC ID: 3678994746 Enrollment ID: I20230622000701 |
| Provider Name | Alyssa Weyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598386039 PECOS PAC ID: 2163843285 Enrollment ID: I20230629002332 |
| Provider Name | Blake M Vincent |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1083747190 PECOS PAC ID: 2567815673 Enrollment ID: I20240125000168 |
| Provider Name | Gerard E Vallejo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285029538 PECOS PAC ID: 0840634754 Enrollment ID: I20240220000493 |
| Provider Name | Shweta Thambad |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831864685 PECOS PAC ID: 6406292127 Enrollment ID: I20240315001751 |
Pure Radiance Laser Retreat Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6722 S Broadway Ave, Tyler, TX 75703 Phone: 903-561-0300 | |
Clifford D. Mullins, D.c., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14653 Eastside Rd, Tyler, TX 75707 Phone: 903-566-4449 | |
Frank P Reuter Jr Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 712 S Bois D Arc Ave, Tyler, TX 75701 Phone: 903-597-5579 Fax: 903-597-5722 | |
David W Ball Md Internal Medicine Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5407 New Copeland Rd Ste 200, Tyler, TX 75703 Phone: 903-330-2081 Fax: 903-630-9309 | |
Integrity Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5605 Old Bullard Rd Ste B, Tyler, TX 75703 Phone: 903-630-5595 Fax: 903-630-5599 | |
Clinica Hispana Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 510 S Southwest Loop 323 Ste 140, Tyler, TX 75702 Phone: 903-530-0240 | |
Bwbl Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6770 Old Jacksonville Hwy Ste 101, Tyler, TX 75703 Phone: 903-352-3250 Fax: 903-221-9183 |