Helping patients discover their path to well-being through personalized, purpose-driven care
Ikigai is the Japanese concept blending passion, talent, purpose and fulfillment. It involves intersecting what you love and are good at and what the world needs and values.
What is Direct Primary Care?
Direct Primary Care (DPC) focuses on the doctor-patient relationship. Your doctor contracts with you directly, not your insurance. You have direct access to your own consistent high quality physician for a low monthly membership fee.
Dr. Kristy Riniker,
MD, MPH, FAAFP, DipABFM
Board Certified American Board of Family Physicians
Fellow American Academy of Family Physicians
Board Certified American Board of Lifestyle Medicine
Master of Public Health, Civil Surgeon
Benefits of Direct Primary Care Membership
Comprehensive primary care
Personalized health care tailored to your needs by an experienced physician dual boarded in family medicine and lifestyle medicine
Direct access to your family physician without call centers
Relaxed extended visits offer quality time with your doctor for you to engage in your healthcare
Same day and next day scheduling
Video visits, phone visits, home visits, email and messaging
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Dr. Riniker’s Philosophy of Medicine
I believe that optimizing your health is an everchanging journey, and I see my role as a guide and resource through this lifelong process. I bring my expertise in evidence based medicine, training in allopathic medicine, pharmacology, lifestyle medicine, complementary and alternative medicine, public health, anthropology, sociology, health care systems. You bring your own expertise in your lived experience, knowledge of your own body, and your own personal and professional mastery. I prefer to get to know you and your health goals and treatment preferences then work together to create an individualized sustainable health care plan integrating healthy lifestyle and medications and supplements as needed and desired.
Services
Direct Access to Dr. Riniker via phone, email, messaging
Visits via video, in person at her office or in your home
Comprehensive Physical Exams for All Ages
Lifestyle Medicine & Chronic Condition Management
Procedures
Urgent Care
Same or Next Day
In Person or Virtual
Newborn Exams
Well Child Checks
Sports Physicals
Well Woman Exams
Annual Physicals
School and Employment Exams
Immigration Physicals
Diabetes, Prediabetes
High Blood Pressure
High Cholesterol
Thyroid Problems
COPD, Asthma
Metabolically Associated Fatty Liver
Obesity, Weight Management
Depression, Anxiety
Insomnia
Point of Care Ultrasound
Trigger Point Injections
Joint Injections
Skin Biopsies
Lesion Removals
Nexplanon & IUDs
Minor injuries
Asthma exacerbations
Respiratory infections
Urinary tract infections
Sexually transmitted infections
Ear infections
Skin infections
Abdominal pain
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Ikigai Family Medicine
Eat Plants
Keep Moving
Sleep Well
Be Present
Stay Calm
Love People
Dr. Riniker is a family physician with over 10 years of experience caring for patients of all ages and backgrounds. She received her BA in cultural anthropology at the University of Texas, followed by her Master of Public Health and Medical Degree at UT Health. She completed her family medicine residency at the University of New Mexico - Santa Fe rural training track. She has worked as a primary care physician treating patients of all ages in rural areas of Washington and New Mexico, and she has spent time in the Middle East, Europe, and Central America. After being a leader in healthcare organizations and the community for over 10 years, she decided to open a Direct Primary Care (DPC) practice in order to fill the need she sees in the community for accessible high quality family physicians. Her goal is to build relationships with her patients and use her medical expertise, education, and experience with each individual patient's goals expertise in their lived experience to help them reach their goals for health and ikigai.
Meet Dr. Riniker
Location
Dr. Riniker believes that being a family physician means caring for the whole person where they live, work and pray in the community. You are invited to schedule a visit at her office in her home, or she will come to your home or location of your choosing, or meet with you over video or phone.
Request to Schedule an Appointment
(Members Only)
Request a Meet & Greet with Dr. Riniker
Dr. Riniker would love to spend time getting to know you and your health goals and discuss what this model of health care can offer you before you make a decision about becoming a member. Schedule a 30 minute meet and greet. Note that no medical decision making will be done during this appointment and you are under no financial obligation. This appointment can be done in person at Dr. Riniker's office, at your home, or via video.
Frequently Asked Questions
What is direct primary care (DPC)?
Direct Primary Care or DPC, is a growing medical practice model that is focused on the doctor-patient relationship. Your doctor will contract with you, not your insurance, to provide convenient, comprehensive and efficient primary healthcare and coordination. By providing primary care services for a directly paid fee, patients get direct access to their doctor without copays or deductibles. With direct access to the doctor, patients can contact their doctor by phone, email, or video chat. DPC offers unhurried office visits and access to discounts on other services all without the use of insurance.
Is Direct Primary Care the same as concierge medicine?
No. Concierge medicine and Direct Primary Care are often thought of as the same because they do share some similarities. Both concierge and DPC limit patient panel size and charge a monthly or annual fee, but concierge fees are often much higher than DPC. Additionally, concierge medicine often continues to charge co-pays for each visit and bills insurance. DPC is a model based on a direct relationship between the doctor and the patient, bypassing insurance to reduce costs, making it more affordable and accessible for patients. There are no co-pays, deductibles or hidden charges.
What sets Ikigai Family Physician or Direct Primary Care apart from other practices?
Direct Access. We have cut the red tape of bureaucracy. The restrictions that typically leave doctors in a traditional healthcare setting buried in paperwork and regulation are lifted through direct care, allowing us to spend our time where it really counts: with patients. By removing any interference with the sanctity of the doctor-patient relationship, we have returned family practice medicine to its root values of clinical excellence and compassionate caring of every patient.
Will I benefit from Ikigai Family Medicine if I don’t require frequent medical attention?
Our practice is dedicated to getting to know you as a person and patient. Whether we only see you once a year or every month, we believe that the value of the doctor-patient relationship is something everyone can benefit from to maintain good health and prevent disease or to just be here when you need us. We hope to change the culture from reactive to proactive medicine. We can give you access and time with your doctor that is relaxed and easygoing and overtime we will get to know you in a way that is invaluable to your care in the future.
Is DPC insurance?
No, DPC is not insurance. The monthly membership fee is your payment for ongoing primary care services offered by your doctor. We strongly recommend that patients maintain health insurance for care that may be needed beyond what we offer (specialty care, ER or hospitalization, surgery, etc.). Direct primary care couples nicely with a high deductible “catastrophic” policy.
Do you take my insurance?
No, we do not accept or bill health insurance. In the DPC model, we contract directly with the patient, not an insurance company. By eliminating the restrictions associated with health insurance, we keep costs low and spend as much time as needed with our patients. Insurance may be needed in specific and catastrophic situations, and we strongly recommend that you do have insurance for these potentially unforeseen situations.
Think of DPC like your car or home owner’s insurance. You probably wouldn’t file an insurance claim for maintenance or a minor repair because of the hassle to do so and your premiums may go up. However, if you crash your car into your house, you need your insurance to cover the potentially catastrophic damages. You may find that much of the care you receive through DPC costs less than it would if you were using insurance.
If I have insurance, can I still use it?
Yes. You can continue to use your insurance as usual for prescriptions, imaging, specialists, hospitalizations, etc. DPC is considered an “out of network” provider and most insurances, except HMO policies, will still cover tests, consultations and procedures ordered by out of network providers.
If I have Medicare, can I still become a patient?
Absolutely! You will need to sign a one-time waiver declaring that neither you nor our office will directly bill Medicare for our services. You can continue to use Medicare for laboratory testing, imaging, and medications prescribed by our office, as well as specialty care and hospitalizations.
Are my service charges tax deductible?
In most cases yes. You may need to consult with your accountant or attorney, but recent executive government policy changes have cleared up the gray area for Direct Primary Care coverage as a "medical expense". For more information visit www.dpcfrontier.com.
Can I use my Flex Spending (FSA) or Health Savings Account (HSA) card?
In most cases yes. Check with your FSA/HSA employer to make sure, but recent executive government policy changes have cleared up the gray area with membership fees vs. a fee for a specific service. For more information visit www.dpcfrontier.com.
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Are there any additional costs beyond the membership fee?
Our membership fee covers most primary care services, however there may be additional costs for labs, medications, specialist consultations, which will be communicated to you.
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What forms of payment do you take?
Cash, Checks or Automatic Bank Transfer are the preferred methods of payment. Credit Cards/FSA/HSA are accepted, but there will be an additional 4% convenience fee for card processing.
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What happens if I need to be hospitalized or see a specialist?
Your care is of most importance to us and at times it may be necessary and very important for you to see a specialist or be hospitalized. In this case, we will work closely with your specialist or hospital doctor to coordinate your care.
Do you see children in your practice?
Yes! We are a family medicine practice and are trained to care for patients of all ages. We do not currently provide routine vaccinations for young children, but we will work with you to arrange necessary vaccines.
What if I need medical care while I’m traveling?
This is one of the benefits of being a patient of Ikigai Family Medicine —because we know you well, we can usually care for you even when you’re away from home. Many illnesses can be diagnosed and treated by communication through by phone, secure patient portal, or video chat. If necessary and appropriate, we can call prescriptions into the pharmacy nearest you.
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What is your service area for home visits?
The service area includes the communities of Rio Rancho, Corrales, Bernalillo, and Albuquerque. The boundaries are 550 to the north, 423 to the south, the Rio Grande to the east, Unser to the West. Home visits outside of these areas will be charged travel time.
Will I have access to my medical records?
Your medical records are kept in a secure electronic file and are your property. If you need copies, just let us know. A patient portal is also available where some records can be accessed by the patient at anytime.
Do you share any medical records with insurance carriers or pharmaceutical companies?
No, unless you specifically request it. We take your privacy seriously, and we are not obligated to provide any third party with a copy of your records unless you specifically ask that we do and sign a release of records.
Is there a contract? How long is the contract?
If you decide to become a member then on your first visit, we will go over and sign the contract for yourself (and your family members, if applicable). The contract operates on a quarterly billing basis; however, you may choose to pay upfront 6 or 12 months in advance, or we can make arrangements for monthly billing if needed. There are no long-term contracts, so you may terminate your membership at any time. If you decide to leave Ikigai Family Physician, or if your payments lapse, the fee to re-enroll is $200.
What is your policy on controlled substances?
The rate of deaths in our country, state and community from overdoses are growing exponentially. Out of respect for our patients, their families and our community, chronic controlled substances will not be prescribed. We believe that controlled substances, both narcotics (like Oxycodone or Oxycontin, etc.) and benzodiazepines (such as clonazepam and Xanax, etc.), have a limited role in primary care and therefore Dr. Riniker prescribes them rarely and only very sparingly. We are happy to work with you on non-narcotic options for your pain and to manage your other medical conditions. We do not treat anxiety with benzodiazepines, but are happy to offer other medications and techniques often successful in treating anxiety. No controlled substances are kept in the office.
If I enroll as a patient of Ikigai Family Medicine, when does billing begin?
At your first visit, both your enrollment fee and your first quarterly membership fee will be due at time of service. Following that, you can choose to pay quarterly, 6 months at a time or annually. Members who pay annually upfront will receive a 5% discount. Membership fees are otherwise due on the 1st of each quarter. Please note that medical care will not be provided through email, video chat or phone prior to an initial face to face appointment and exam.
How will I know if Ikigai Family Physician is right for me?
Come get to know us with a free 15-minute meet and greet. We can answer your questions about our practice and Direct Primary Care in relation to your healthcare situation. Please note that medical decision-making care will not be provided as part of the meet and greet.
Immigration Medical Exams
Overview
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The immigration medical exam consists of four components:
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Screening test(s) - you will go to the laboratory for blood test(s). Urine testing may also be needed for younger adult applicants. This part may be completed before your appointment.
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Vaccination/immunizations - you will need to complete all vaccination requirements deemed necessary by USCIS. Please send us your vaccination records using this secure link. This part may be completed before your appointment.​​
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Medical history - this is completed on the day of your immigration exam appointment.
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Physical examination - this is completed on the day of your immigration exam appointment.
What do I need to bring?
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Please fill out the I-693 form parts 1 through 4
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Government-issued photo identification, such as a valid passport or driver’s license.
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​Those who are 14 years old or younger: bring identification that shows your name, date and place of birth, and parent’s full name. Possible forms of identification include your birth certificate (with an English translation) or an affidavit.
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Vaccination/immunization records (please see the section on "which vaccines are required?")
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You may send vaccination records securely for our civil surgeon to review before your immigration exam appointment.
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Any past medical documents
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If you are not fluent in English, you will need to bring an interpreter to your appointment.
How much does it cost?
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Health insurance plans do not cover these immigration exams because they are considered administrative exams.
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Per person, the cost of the immigration exam is $250. This includes:
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Orders for screening lab tests that are required by USCIS (screening for gonorrhea, syphilis and tuberculosis)
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Please note: the screening tests must be ordered by a US Civil Surgeon. Results of testing that was ordered by an outside physician are not accepted for immigration purposes.
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Immigration medical exam
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Evaluation of immunizations​
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Completion of the I-693 form by our physician
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Cost of labs:
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Infectious screening: $306 without insurance
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If you prefer to use your health insurance for the screening lab tests, please check with your insurance plan to ask whether lab tests are covered. Here are the codes you will need:​​​​
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Gonorrhea NAA: CPT code 87591. Diagnosis code Z11.3​
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RPR: CPT code 86592. Diagnosis code z11.3
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Quantiferon: CPT code: 86480. Diagnosis code z11.1​
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If you do not have record of immunizations, you have the option to be tested for titers. Cost ranges from $65 to $299 depending on what immunizations are lacking. ​
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Hepatitis B titer: CPT code 86706. Diagnosis code z01.84
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MMR titer: CPT codes 86735, 86762, and 86765. Diagnosis code z01.84
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Varicella titer: CPT code 86787. Diagnosis code z01.84
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What to expect?
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You will need to go to Quest or Labcorp to complete the required screening lab test(s).
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This step may be completed before the immigration exam appointment for those who would like to expedite the process.
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If this is not completed before the immigration exam, we will order the lab tests on the day of your exam. After your exam, you will go to have your blood drawn, and urine collected (if needed).
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During your immigration exam appointment, we will gather information about your identity, vaccinations, and medical history.
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We will also check your weight, height, vital signs, and perform a general physical exam.
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If you are missing required vaccines, we will let you know which ones you need
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We do not have vaccinations in our office. You can get vaccines at a nearby pharmacy or a local health department.​
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After completing the required vaccinations, you may send us the record or receipts securely
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If you have a chronic medical condition (such as hypertension or diabetes), you may need to get a supporting letter from your primary care doctor or specialist, and they may need to sign part of the I-693 (page 11). This can add extra time depending on how fast you can request this documentation from your doctor.
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Lab results are usually available within 5-7 days. When we receive the results, we will review them and contact you if there are any concerns.
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​​If your screening tests are abnormal, you may need additional office visits for treatment and follow-up. ​There may be additional costs involved if you need additional treatment or testing.
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Once all of your labs results have been received (if normal), and you have received your required vaccinations, you will receive notification when your envelopes are ready for pick up at the office.
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You will receive a sealed envelope, and a copy of the completed I-693 form for your records.
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Which lab tests are required?
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USCIS requires testing for the following:
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Tuberculosis (blood test) for anyone 2 years and older
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Syphilis (blood test) for adults ages 18-44
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Gonorrhea (urine test) for adults ages 18-24
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Which vaccines are required?
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For most healthy adults under age 65, the following are required:
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One dose of the Tetanus, Diptheria, and Pertussis (Tdap) vaccine within the last 10 years if you have received primary vaccination series for tetanus, dipthteria, and pertussis.
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Those who have not completed the primary series will need the dose that is due at the time of the medical exam
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3 dose series: 1 dose Tdap, followed by 1 dose Td or Tdap at least 4 weeks later, and a third dose of Td or Tdap 6–12 months later.
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3 doses of the Polio (OPV/IPV) vaccine
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Adults who have not completed the primary vaccine series will need the dose that is due at the time of the medical exam
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3 dose series with at least 4 weeks between Dose 1 and 2 and 6 months between Dose 2 and 3).
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The last dose of the polio series must be given at age 4 or older.​
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2 to 3 doses of the Hepatitis B vaccine.
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If you are unvaccinated against Hepatitis B, you will need the dose that is due at the time of the medical exam
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​2 dose series Heplisav-B
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At least 4 weeks between Dose 1 and 2
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3 dose series Engerix-B, PreHevbrio, or RecombivaxHB
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At least 4 weeks between Dose 1 and 2, 8 weeks between Dose 2 and 3, and 16 weeks between Dose 1 and 3
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3 dose series HepA-HepB (Twinrix)
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At least 4 weeks between Dose 1 and 2, 5 months between Dose 2 and 3, and 6 months between Dose 1 and 3
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Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons
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If you think you may have received Hep B vaccinations but don’t have your vaccine record, you can request an extra blood test to check for immunity against Hepatitis B (extra cost of $16).
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1 dose of the Measles, Mumps, and Rubella (MMR) vaccine.
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If you are unvaccinated, you will need to get at least one dose in order to meet the requirement.
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If there is a chance you could be pregnant, take a pregnancy test before receiving the MMR vaccine because this is a live vaccine.
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If you think you received these vaccines but don’t have your vaccine record, you can request an extra blood test to check for immunity against these (extra cost of $16).
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2 doses of the varicella (chickenpox) vaccine OR a history of having chickenpox/varicella in the past.
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If you are uncertain whether you had chickenpox or got the vaccine, an extra blood test can be done to check for immunity (extra cost of $16).
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If there is a chance you could be pregnant, take a pregnancy test before receiving the varicella vaccine because this is a live vaccine.
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If you never had chickenpox and are unvaccinated, you will need the dose that is due at the time of the medical exam
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If you are over 50, you may be required to have the shingles vaccine, which is a particular version of the varicella vaccine for older adults.​​
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One dose of the current seasonal influenza vaccine if it is flu season (Sept 1 - March 31).
For adults 65 and older, or adults with chronic health conditions, additional vaccines may be required, including a pneumonia vaccine (PCV20).
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For children/teens, the list is much longer and may include vaccines depending on age:
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DTaP, Polio, Hib, PCV, Rotavirus, Hepatitis A, and Meningococcus.
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What if I don’t have any vaccine records?
Extra blood tests can be ordered to check for immunity against certain diseases, including hepatitis B, measles, mumps, rubella, and varicella (chickenpox). The Hep B, varicella, and MMR titers cost $16 each.
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For all other vaccines, if you do not have documentation, you will have to receive at least one dose of each vaccine. For certain vaccines, if you do not have proof of completing the childhood vaccination series, you will need the dose that is due at the time of the immigration exam. Please discuss with Dr. Nguyen.
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What if my records are not in English?
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For records in any language other than English, you need to pay a professional to provide a certified translated copy and bring this to your first appointment. You can search for these services online.
Where can I get the vaccines I need?
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Currently, we do not have vaccinations available in our office. You can get the vaccines at any pharmacy or the public health department.​
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​Be sure to ask for a receipt that includes the name of the vaccine(s), the date of administration, etc.
What if I object to vaccination?
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You need to obtain a blanket vaccine waiver through USCIS. You can still complete the medical exam and get the completed I-693 form, but I must check the box: “Applicant will request an individual waiver based on religious or moral convictions.”
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Whether your waiver is approved by USCIS or not is completely up to USCIS. If your waiver is declined, you may need to pay to complete the process again.
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How long does it take to get the completed I-693 form?
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​If you complete all of your vaccinations on time, AND all of your lab results are normal, then the process typically takes one week.
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If you have any abnormal test results or a chronic medical condition, or if you are missing vaccines, the process may take longer.
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