NPIMap

Organization Active NPI

219 Health Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
National Provider Identifier
1003410085
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
219 HEALTH NETWORK, INC.
Practice address
4320 Fir St Unit 216
East Chicago, IN 46312-3076
Phone
(219) 392-7025
NPI assigned
Nov 30, 2020
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
William Cortes
Title
Executive Director
Phone
(219) 703-2585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4320 Fir St Unit 216
East Chicago, IN 46312-3076

Mailing address

4320 Fir St Unit 216
East Chicago, IN 46312-3076

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201214000484 IN Part A Provider - Federally Qualified Health Center (FQHC) 0547521452 Practice locations: East Chicago, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003410085. Details of each certification follow.

Federally qualified health center certification: CCN 151088

Legal name
219 HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2020
Last certification
Dec 14, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4320 Fir St
Unit 216
East Chicago, IN 46312-3076

National Provider Directory

National Provider Directory
Tax ID family
219 Health Network Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

4320 Fir St
Unit 216
East Chicago, IN 46312
Phone (219) 392-7025

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Luis Molina Individual Corporate DirectorBoard Member - Treasurer May 1, 2018
Reginald Jones Individual Corporate DirectorBoard Member May 1, 2018
William Cortes Individual Corporate DirectorExecutive Director Mar 31, 2024
W-2 Managing EmployeeExecutive Director Mar 31, 2024
Gloria Vela Individual Corporate DirectorBoard Member May 1, 2018
Marjol Rush-Collet Individual Corporate Director May 1, 2018
Andrea Sherwin Individual Corporate DirectorBoard Member Nov 1, 2020
Leo Correa Individual Corporate DirectorChairman May 1, 2018
Sandra Noe Individual Corporate DirectorBoard Member - Secretary May 1, 2018
Milton Reed Individual Corporate DirectorBoard Member May 1, 2020
Sara Jiminez Individual Corporate DirectorDirector May 1, 2018

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1003410085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 FIR ST UNIT 216",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 FIR ST UNIT 216",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123076",
            "telephone_number": "219-392-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-30",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "CORTES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "219-703-2585"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Chicago, IN

Sources for this page

Verify at the official NPI Registry.