Devika Icecreamwala, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

148974 Issued in CA

Practice address

6605 Nancy Ridge Dr
San Diego, CA 92121-2253

Phone

(858) 900-2747

Fax

(858) 750-2984

NPI assigned

Mar 21, 2012

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 names 1

• Devika Patel Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Dermatology

Education

University of Missouri, Kansas City, School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Compass Dermatopathology IncGroup PAC ID 7113112558, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Compass Dermatopathology, Inc.

  • Dermatopathology Physician
  • San Diego, CA
  • NPI 1922312248

  Dermatology

  Medicare reassignment Care Compare group NPD
• California Pacific Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Oakland, CA
  • NPI 1275002453
  NPD (past)

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1639444748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6605 NANCY RIDGE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212253",
            "telephone_number": "858-900-2747",
            "fax_number": "858-750-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6605 NANCY RIDGE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212253",
            "telephone_number": "858-900-2747",
            "fax_number": "858-750-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICECREAMWALA",
        "first_name": "DEVIKA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "148974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEVIKA",
            "last_name": "PATEL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Icare-USA LLC
• Lecia Icari
• Vanessa Icazbalceta-Soto
• Eden Shanay Ice
• William Ice
• Icedown
• Jacob Ichimaru
• Michael Ichiyama, PH.D.
• Joshua Ichull Ingya
• Caleb Fanen Ichull-Ingya

• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.