NPIMap

Organization Active NPI

Healthlinc, Inc.

  • Federally Qualified Health Center (FQHC)
  • Michigan City, IN
National Provider Identifier
1013105568
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
H80CS06662 Issued in IN
Legal business name
HEALTHLINC, INC.
Practice address
200 Alfred St
Michigan City, IN 46360
Phone
(219) 413-5100
NPI assigned
Oct 10, 2007
Organization subpart
Yes
Parent organization
HEALTHLINC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Melissa Mitchell
Title
Ceo
Phone
(219) 465-9503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X H80CS06662 IN Primary

Addresses

Primary practice location

200 Alfred St
Michigan City, IN 46360

Mailing address

2401 Valley Dr
Valparaiso, IN 46383-2520
Phone (219) 413-5100

Other identifiers 1

IdentifierTypeStateIssuer
200317310BMedicaidIN

Other names 1

  • HealthLinc - Michigan City Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050210000929 IN Part B Supplier - Clinic/Group Practice 7618929373 Receives reassigned benefits from 194 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Valparaiso, IN; South Bend, IN; Morocco, IN; Michigan City, IN; Mishawaka, IN; East Chicago, IN; Knox, IN; La Porte, IN…
O20071008000340 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618929373 Practice locations: Michigan City, IN

Federally qualified health center certification: CCN 151845

Legal name
HEALTHLINC INC
Doing business as
HEALTHLINC - MICHIGAN CITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2007
Last certification
Oct 31, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 31, 2001 in IN
Enrollment address
200 Alfred St
Michigan City, IN 46360-7303

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Part of
Healthlinc Inc

Member of 1

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

Networks

  • OH PPO

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kristine E Jennings Individual Corporate OfficerBoard Members Dec 1, 2023
Corporate DirectorBoard Member Dec 1, 2023
Shery a Roussarie Individual Corporate DirectorBoard Member Sep 21, 2020
Susan Thorner Individual Corporate DirectorBoard Member May 16, 2022
Sandra Goldberg Individual Corporate DirectorBoard Member Nov 1, 2023
Donald Dixon Individual Corporate OfficerBoard Member Dec 1, 2023
Corporate DirectorBoard Member Dec 1, 2023
Robert Franko Individual Corporate DirectorBoard Member Sep 16, 2019
Chanthini Fowler Individual Corporate DirectorBoard Member May 16, 2022
Stephen Massa Individual Corporate DirectorBoard Member Oct 21, 2019
Christopher C Jordan Individual Corporate DirectorBoard Member May 15, 2023
Marcos Rodriguez Individual Corporate OfficerBoard Member Aug 18, 2025
Corporate DirectorBoard Member Aug 18, 2025
David Pearman Individual Corporate DirectorBoard Member May 16, 2022
Melissa Mitchell Individual Corporate DirectorCeo Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
Ehiman Uwidia Individual Corporate OfficerBoard Member Jul 1, 2024
Corporate DirectorBoard Member Jul 1, 2024
Jennifer Stall Individual Corporate DirectorBoard Member Jan 17, 2023
Patricia Terrell Individual Corporate DirectorBoard Member Jun 18, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Healthlinc - KnoxKnox, IN, CCN 151851 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 31, 2001
Healthlinc - MishawakaMishawaka, IN, CCN 151873 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 31, 2011
Healthlinc - East ChicagoEast Chicago, IN, CCN 151901 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 31, 2001
Healthlinc - Iusb DentalSouth Bend, IN, CCN 151952 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 31, 2001
Healthlinc - South Bend (Medical)South Bend, IN, CCN 151965 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 31, 2001
Healthlinc - CentennialSouth Bend, IN, CCN 151025 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 31, 2001
Healthlinc - SoutheastSouth Bend, IN, CCN 151026 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 19, 2018
Healthlinc LaporteLa Porte, IN, CCN 151052 Federally qualified health center 5% Or Greater Direct Ownership Interest May 31, 2001

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1013105568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 VALLEY DR",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832520",
            "telephone_number": "219-413-5100",
            "fax_number": "219-465-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ALFRED ST",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "46360",
            "telephone_number": "219-413-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHLINC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHLINC, INC.",
        "enumeration_date": "2007-10-10",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-465-9503"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IN",
            "license": "H80CS06662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200317310B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthLinc - Michigan City",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HealthLinc - Michigan City",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Michigan City, IN

Sources for this page

Verify at the official NPI Registry.