Individual provider Active NPI

Karla Renise Ivy, D.O.

  • Family Medicine Physician
  • Jbsa Randolph, TX
National Provider Identifier
1780066035
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1745 Issued in NE
Practice address
221 3Rd St W BLDG 1040
Jbsa Randolph, TX 78150-4800
Phone
(210) 652-5363
NPI assigned
Jun 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1745 NE Primary

Addresses

Primary practice location

221 3Rd St W BLDG 1040
Jbsa Randolph, TX 78150-4800

Mailing address

221 3Rd St W BLDG 1040
Jbsa Randolph, TX 78150-4800
Phone (210) 652-5363

Other practice location 1

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (210) 652-5363

Other practice location 2

11130 Christus Hls Fl 3
San Antonio, TX 78251-3585
Phone (210) 703-9001

Other names 1

  • Karla Renise Rinschen Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220715000278 TX Practitioner - Family Practice 6002105178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

11130 Christus HLS
San Antonio, TX 78251-3585
Phone (210) 228-0044

11212 State Hwy
151 Suite 230
San Antonio, TX 78251-4501
Phone (830) 643-7000

11212 State Hwy 151
Suite 230
San Antonio, TX 78251-4501
Phone (830) 643-7000

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1745NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Aug 1, 2022 Accepting new patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Christus Santa Rosa Health Care Corporation Past Accepting new patients
Trinity Clinic Past Accepting new patients

Locations

11130 Christus Hls
Fl 3
San Antonio, TX 78251
Phone (210) 703-9001

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Interoperability endpoints

  • Direct secure messaging: kivy283375@christushealth.direct-ci.net

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1780066035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-5363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3551 Roger Brooke Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Sam Houston",
            "state": "TX",
            "postal_code": "782344504",
            "country_code": "US",
            "telephone_number": "210-652-5363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11130 Christus Hls Fl 3",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782513585",
            "country_code": "US",
            "telephone_number": "210-703-9001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVY",
        "first_name": "KARLA",
        "middle_name": "RENISE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-23",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "1745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARLA",
            "last_name": "RINSCHEN",
            "middle_name": "RENISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jbsa Randolph, TX

Sources for this page

Verify at the official NPI Registry.