Individual provider Active NPI

Icelind Ruby Gallardo

  • Family Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1427588797
Registry record updated Feb 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1074110 Issued in TX
Practice address
7603 Culebra Rd
San Antonio, TX 78251-1437
Phone
(663) 892-7278
NPI assigned
Jun 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 787387 CA
Family Nurse Practitioner 363LF0000X 1074110 TX Primary

Addresses

Primary practice location

7603 Culebra Rd
San Antonio, TX 78251-1437

Mailing address

7603 Culebra Rd
San Antonio, TX 78251-1437
Phone (663) 892-7278

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220802003689 TX Practitioner - Nurse Practitioner 5991187247 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
81.85 of 100Reported as group
Quality
78.01
Improvement activities
40
Cost
79.8

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
787387CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostic of Texas PLLC CurrentSince Feb 15, 2024 Accepting new patients
Primary Care PLLC Family CurrentSince Sep 19, 2024 Accepting new patients
Minuteclinic Telehealth Services of Texas Association Family CurrentSince Feb 15, 2024 Accepting new patients
Minuteclinic Diagnostic of Texas PLLC Family CurrentSince Feb 15, 2024 Accepting new patients

Locations

1540 E Main St
Allen, TX 75002
Phone (214) 383-9765

5526 S Congress Ave
Austin, TX 78745
Phone (512) 462-3820

601 N Industrial Blvd
Bedford, TX 76021
Phone (817) 283-0161

2469 Bay Area Blvd
Houston, TX 77058
Phone (281) 474-4042

3103 Fry Rd
Katy, TX 77449
Phone (281) 646-2964

5002 W Main St
League City, TX 77573
Phone (281) 557-4374

1413 Oates Dr
Mesquite, TX 75150
Phone (972) 613-7001

2712 Highway 365
Nederland, TX 77627
Phone (409) 721-5846

9522 Broadway St
Pearland, TX 77584
Phone (713) 436-8151

1855 Gattis School Rd
Round Rock, TX 78664
Phone (512) 238-6268

23530 Wilderness Oak
San Antonio, TX 78258
Phone (210) 385-8306

5301 Alamo Pkwy
San Antonio, TX 78253
Phone (210) 688-9311

7603 Culebra Rd
San Antonio, TX 78251
Phone (210) 680-0299

Organizations & group practices 4

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": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707523200000",
    "number": "1427588797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7603 CULEBRA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782511437",
            "telephone_number": "663-892-7278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7603 CULEBRA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782511437",
            "telephone_number": "663-892-7278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLARDO",
        "first_name": "ICELIND",
        "middle_name": "RUBY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "787387",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1074110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.