Icp Ppo, LLC

Icp Ppo, LLC is a healthcare organization registered as Preferred Provider Organization in South Bend, IN, holding Type 2 (organization) NPI 1407443617 since 2020. The authorized official on file is Kelly Macken - Marble, President.

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NPI	1407443617
Entity type	Organization (Type 2)
Legal business name	Icp Ppo, LLC
Practice address	211 N EDDY ST, South Bend, IN, 46617
Phone	5742348161
Enumeration date	2020-12-22
Last updated in NPPES	2020-12-22

Authorized official

Name	Kelly Macken - Marble
Title	President
Phone	2183931566

Taxonomy & classification

Taxonomy code	Specialty	Primary	License	State
174400000X	Specialist	Secondary	—	—
305R00000X	Preferred Provider Organization	Primary	—	—

Copy-ready billing details

Provider: Icp Ppo, LLC
NPI: 1407443617
Taxonomy: 305R00000X (Preferred Provider Organization)
Address: 211 N EDDY ST, South Bend, IN, 46617

Providers at this address

NPI	Name	Type	Specialty	Location
1386560043	Amanda Troyer	Individual	Registered Nurse First Assistant	South Bend, IN
1811992803	Kathleen Delnay	Individual	Urology Physician	South Bend, IN
1073511598	Ron Clark	Individual	Orthopaedic Surgery Physician	South Bend, IN
1669471827	Jay Biesenthal	Individual	Certified Registered Nurse Anesthetist	South Bend, IN
1033119904	Regina Jasiewicz	Individual	Family Nurse Practitioner	South Bend, IN
1548255292	Jeff Niespodziany	Individual	Podiatrist	South Bend, IN
1659366276	Randall Kline	Individual	Foot & Ankle Surgery Podiatrist	South Bend, IN
1093704801	Ahmed Abdel-Latief	Individual	Cardiovascular Disease Physician	South Bend, IN

Verify this record

Cross-check NPI 1407443617 against the authoritative CMS record: view Icp Ppo, LLC on the official NPPES registry .

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.

Frequently asked questions

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2020-12-22. Verify at npiregistry.cms.hhs.gov.

Where is Icp Ppo, LLC located?

The practice location on file with NPPES is in South Bend, IN.

Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2020-12-22.