Diane M Icenogle Leuschen, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

J8600 Issued in TX

Practice address

7400 Merton Minter
San Antonio, TX 78229-4404

Phone

(210) 617-5300

Fax

(210) 949-3350

NPI assigned

Dec 22, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Four Seasons Breast Foundation

  • Mammography Clinic/Center
  • San Antonio, TX
  • NPI 1770756660
  NPD (past)
• Opensided MRI of San Antonio LLC

  • Magnetic Resonance Imaging Radiologic Technologist
  • San Antonio, TX
  • NPI 1417984493
  NPD (past)
• Radiology Associates of San Antonio,P.a.

  dba Advanced Medical Imaging

  • Diagnostic Radiology Physician
  • San Antonio, TX
  • NPI 1700861572
  NPD (past)

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255478400000",
    "number": "1508842311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 MERTON MINTER",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294404",
            "telephone_number": "210-617-5300",
            "fax_number": "210-949-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 MERTON MINTER",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294404",
            "telephone_number": "210-617-5300",
            "fax_number": "210-949-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICENOGLE LEUSCHEN",
        "first_name": "DIANE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2009-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J8600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "J8600",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "8D8214",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abisola Ibrahim, WHNP/AGPCNP
• Ali Mahmoud Ibrahim, DDS
• Batool Ibrahim
• Icare Transport Solutions LLC
• Catalina Ice, DNP
• Lisa Ann Icke
• Christina D Idar, M.A., CCC-SLP
• Dawn Idar
• Karen Kay Idar, LMT
• Michelle Idar

• Diagnostic Radiology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.