DEVIKA ICECREAMWALA (MD) – Dermatology Physician, NPI 1639444748

DEVIKA ICECREAMWALA (MD) is a healthcare provider. based in Detroit, Michigan. specializing in DERMATOLOGY. They hold the professional credentials MD. They hold a License No. 148974 (CA). The NPI Number for DEVIKA ICECREAMWALA (MD) is 1639444748

Main info

Female
14 Years Of Experience
Accepts Medicare Assignment
Name
DEVIKA ICECREAMWALA (MD)
NPI
1639444748
Phone
(313) 745-4405
Address
4201 ST. ANTOINE - UHC 5D - MAILBOX #226
Enumeration Date
21 March 2012
Last Update Date
4 November 2024

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
Secondary Phone
8587502983
Graduation Year
2012 (14 years ago)
PAC ID
5496987968
Group Practice PAC ID
7113112558
Professional Enrollment ID
I20171031003045
Address ID
CA921212253SA6605XDRXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience62
Completeness75
Years active:14State licenses:1Digital endpointsOther names

2,140 DERMATOLOGY in CA

Provider Addresses for DEVIKA ICECREAMWALA (MD)

  • 4201 ST. ANTOINE - UHC 5D - MAILBOX #226

    UNIVERSITY PEDIATRICIANS

    DETROIT, MI 482012153

    Phone: (313) 745-4405

    Fax: (313) 966-0665

    Type: Mailing

  • 4000 DUBLIN BLVD

    DUBLIN, CA 945683113

    Phone: (925) 875-6100

    Type: Location

  • 6605 NANCY RIDGE DR

    SAN DIEGO, CA 921212253

    Phone: (858) 900-2747

    Fax: (858) 750-2984

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 51 Open Payments records for all available years, with a total value of $1,307.

Total Amount is formed as General ($1,307) + Research ($0) + Ownership ($0) = $1,307.

Last reported payment date: 2024-12-09 • Largest payer in this snapshot: ABBVIE INC. ($405).

Total Amount

$1,307

General + Research + Ownership

Payments

51

Total payment records

General Amount

$1,307

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-09

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-10-31

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20171031003045IDermatologyCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths15324$0
99213Established patient office or other outpatient visit, 20-29 minutes8857$0
17000Destruction of precancer skin growth, 1 growth4833$0
11102Biopsy of related skin growth, first growth3431$0
99203New patient office or other outpatient visit, 30-44 minutes2929$0
View full utilization report →

Insurance plans in this area (ZIP 48201)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7113112558View full group profile
NameSpecialtyState
P A T H O L O G YNM
Pathology, DermatologyCA
D E R M A T O L O G YCA
Physician AssistantCA
D E R M A T O L O G YCA

Reviews

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Frequently asked questions

How do I look up DEVIKA ICECREAMWALA (MD) by NPI?
Use NPI 1639444748 when you need to reference DEVIKA ICECREAMWALA (MD) in forms, claims, or directories.
Is DEVIKA ICECREAMWALA (MD) active in the national directory?
DEVIKA ICECREAMWALA (MD)'s public NPI profile is in an active state.
What field does DEVIKA ICECREAMWALA (MD) work in?
You can think of DEVIKA ICECREAMWALA (MD) as practicing within Dermatology Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for DEVIKA ICECREAMWALA (MD)?
The page summarizes Detroit, Michigan for DEVIKA ICECREAMWALA (MD); expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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