Independent Care Health Plan

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

INDEPENDENT CARE HEALTH PLAN

Practice address

1555 N Rivercenter Dr
Suite 202a
Milwaukee, WI 53212-3981

Phone

(414) 223-4847

Fax

(414) 231-1092

NPI assigned

Jul 31, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Patricia Jerominski

Title

President and Ceo

Phone

(414) 223-4847

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1760648513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 N RIVERCENTER DR",
            "address_2": "SUITE 202A",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123981",
            "telephone_number": "414-223-4847",
            "fax_number": "414-231-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 N RIVERCENTER DR",
            "address_2": "SUITE 202A",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123981",
            "telephone_number": "414-223-4847",
            "fax_number": "414-231-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT CARE HEALTH PLAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-31",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "JEROMINSKI",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "414-223-4847",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.