Anne Mare Ice

Key facts

NPI

1902839764

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Adolescent Medicine Physician 2080A0000X

License

4301031683 (MI)

Practice address

23077 Greenfield Rd Ste 200
Southfield, MI 48075-3750

Phone

(313) 824-1000

NPI assigned

Jul 7, 2006

Sex

Female

Sole proprietor

Yes

Organizations & group practices 3

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.

• Detroit Wayne County Health Authority Federally Qualified Health Center (FQHC) · Detroit, MI · NPI 1245182963
  NPD (past)
• Detroit Wayne County Health Authority Primary Care Clinic/Center · Detroit, MI · NPI 1962733089
  NPD (past)
• Partners in Wellness Family Medicine Physician · Detroit, MI · NPI 1518461524
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19827/brand/1/csg/1/fhir/r4
• Direct secure messaging: anne.mare.ice.1@19827.direct.athenahealth.com
• Direct secure messaging: aice@direct.dmc.org

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 9, 2024.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1902839764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22341 W 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482191217",
            "telephone_number": "313-255-2209",
            "fax_number": "313-255-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753750",
            "telephone_number": "313-824-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12121 Broadstreet Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482041550",
            "country_code": "US",
            "telephone_number": "313-824-1000 x2",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10809 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482142119",
            "country_code": "US",
            "telephone_number": "313-824-1000 x1",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27777 Lahser Rd",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480344751",
            "country_code": "US",
            "telephone_number": "313-824-1000 x2",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22341 W 8 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482191217",
            "country_code": "US",
            "telephone_number": "313-255-2209 x234",
            "fax_number": "313-255-0773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ICE",
        "first_name": "ANNE MARE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MI",
            "license": "4301031683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1066910",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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