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ICP PPO, LLC
NPI 1407443617
Preferred Provider Organization in South Bend, IN

Active since December 22, 2020
211 N EDDY ST, SOUTH BEND, IN 46617(574) 234-8161 Get Directions Write a Review

NPPES record last updated: December 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Icp Ppo, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ICP PPO, LLC (NPI 1407443617) is a healthcare organization registered as a preferred provider organization in South Bend, Indiana and active in the NPI registry since December 2020. The organization lists Kelly Macken - Marble, President, as its authorized official.

NPPES Registry Identity

NPI1407443617
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameICP PPO, LLC
Location Address211 N EDDY STSouth Bend, IN 46617-2808
Mailing Address413 W Montgomery Xrd Ste 602Savannah, GA 31406-3396 · (912) 691-5711
Phone(574) 234-8161
Organization SubpartNo
Authorized OfficialKelly Macken - MarblePresident · (218) 393-1566
Enumeration DateDecember 22, 2020
NPPES CertifiedDecember 22, 2020
✔ NPI 1407443617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
Also ListedSpecialistTaxonomy 174400000X
211 N EDDY ST, South Bend, IN 46617
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AUTUMN MARIE HANNA PA
Physician Assistant
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 234-8161
DR. STEVEN P. CROWELL MD
Internal Medicine
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9340
JESSICA A HECKMAN R.D.
Dietitian, Registered
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9331
LOUIS CAVADINI DO
Family Medicine
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9395
MS. REGINA R. JASIEWICZ FNP
Nurse Practitioner (Family)
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9231
DR. ERSALAN A RAHMAN M.D.
Ophthalmology
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9334
DR. SCOTT H WOLF MD
Radiology (Diagnostic Radiology)
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9203
GABRIELA L TAYLOR PA
Physician Assistant
211 N EDDY ST
SOUTH BEND, IN 46617
St. Joseph County (574) 237-9294

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Icp Ppo, LLC's NPI number?

The NPI number for Icp Ppo, LLC is 1407443617. It was assigned to this organization in the NPPES registry on December 22, 2020.

Where is Icp Ppo, LLC located?

Icp Ppo, LLC is located at 211 N Eddy St, South Bend, IN 46617. The listed phone number is (574) 234-8161.

What is Icp Ppo, LLC's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Icp Ppo, LLC was last updated on December 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.