NPIMap

Organization Active NPI

Icp Louisiana Aco Billing LLC

  • Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1043894231
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ICP LOUISIANA ACO BILLING LLC
Practice address
333 Texas St Ste 1300
Shreveport, LA 71101-3783
Phone
(800) 807-6555
Fax
(855) 316-2999
NPI assigned
May 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Margaret S Pemberton
Title
Vice President
Phone
(502) 394-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

333 Texas St Ste 1300
Shreveport, LA 71101-3783

Mailing address

805 N Whittington Pkwy Ste 200
Louisville, KY 40222-7102
Phone (800) 807-6555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210524001663 LA Part B Supplier - Clinic/Group Practice 6103225164 Receives reassigned benefits from 11 practitioners
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2501 Kenneth St
Ringgold, LA 71068
Phone (318) 214-7948

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1043894231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N WHITTINGTON PKWY STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402227102",
            "telephone_number": "800-807-6555",
            "fax_number": "855-316-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 TEXAS ST STE 1300",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013783",
            "telephone_number": "800-807-6555",
            "fax_number": "855-316-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICP LOUISIANA ACO BILLING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "PEMBERTON",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "502-394-2100"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.