Individual provider Active NPI

Kathy Ann Lacivita, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • San Antonio, TX
National Provider Identifier
1083721153
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
K0101 Issued in TX
Practice address
701 S Zarzamora St
San Antonio, TX 78207-5209
Phone
(210) 358-7000
Fax
(210) 358-7406
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X K0101 TX Primary

Addresses

Primary practice location

701 S Zarzamora St
San Antonio, TX 78207-5209

Mailing address

PO Box 87
San Antonio, TX 78291-0087
Phone (210) 358-9172

Other identifiers 1

IdentifierTypeStateIssuer
104492702MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K0101TXMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medicine Associates CurrentSince Nov 1, 2009 Accepting new patients
Pain Management Specialists PastSince Feb 7, 2021 Accepting new patients

Locations

701 S Zarzamora St
San Antonio, TX 78207
Phone (210) 358-7000

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413417600000",
    "number": "1083721153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782910087",
            "telephone_number": "210-358-9172",
            "fax_number": "210-358-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S ZARZAMORA ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782075209",
            "telephone_number": "210-358-7000",
            "fax_number": "210-358-7406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACIVITA",
        "first_name": "KATHY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2014-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TX",
            "license": "K0101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104492702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.