NPIMap

Organization Active NPI

Healthlinc, Inc

Doing business as HealthLinc - East Chicago Harbor West

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
National Provider Identifier
1063256626
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTHLINC, INC
Doing business as
HealthLinc - East Chicago Harbor West
Practice address
2106 Broadway St
East Chicago, IN 46312-2218
Phone
(219) 413-5118
Fax
(219) 200-5020
NPI assigned
Jun 19, 2024
Last updated
Jun 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

2106 Broadway St
East Chicago, IN 46312-2218

Mailing address

2106 Broadway St
East Chicago, IN 46312-2218

Other names 1

  • HealthLinc - East Chicago Harbor West Doing business as

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…
O20240925000443 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618929373 Practice locations: East Chicago, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063256626. Details of each certification follow.

Federally qualified health center certification: CCN C51064

Legal name
HEALTHLINC INC
Doing business as
HEALTHLINC - EAST CHICAGO HARBOR WEST
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 21, 2024
Last certification
Oct 21, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2106 Broadway St
East Chicago, IN 46312-2218

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Shery a Roussarie Individual Corporate OfficerBoard Member Sep 21, 2020
Corporate DirectorBoard Member Sep 12, 2020
Susan Thorner Individual Corporate OfficerBoard Member May 16, 2022
Corporate DirectorBoard Member May 16, 2022
Sandra Goldberg Individual Corporate OfficerBoard Member Nov 1, 2023
Corporate DirectorBoard Member Nov 1, 2023
Robert Franko Individual Corporate OfficerBoard Member Sep 16, 2011
Corporate DirectorBoard Member Sep 16, 2019
Chanthini Fowler Individual Corporate OfficerBoard Member May 16, 2022
Corporate DirectorBoard Member May 16, 2022
Stephen Massa Individual Corporate OfficerBoard Member Oct 19, 2019
Corporate DirectorBoard Member Oct 19, 2019
Christopher C Jordan Individual Corporate OfficerBoard Member May 15, 2023
Corporate DirectorBoard Member May 15, 2023
David Pearman Individual Corporate OfficerBoard Member May 16, 2022
Corporate DirectorBoard Member May 16, 2022
Christine Atherton Individual Corporate OfficerBoard Member Jun 19, 2017
Corporate DirectorBoard Member Jun 19, 2017
Melissa Mitchell Individual Contracted Managing EmployeeCeo Dec 13, 2023
Corporate OfficerCeo Dec 13, 2023
Corporate DirectorCeo Dec 13, 2023
Jennifer Stall Individual Corporate OfficerBoard Member Jan 17, 2023
Corporate DirectorBoard Member Jan 17, 2023
Patricia Terrell Individual Corporate OfficerBoard Member Jun 18, 2018
Corporate DirectorBoard Member Jun 18, 2018

Owners & managing parties with NPI records 1

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.

  • Healthlinc, Inc
    • Federally Qualified Health Center (FQHC)
    • La Porte, IN
    • NPI 1538728399

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc

    dba HealthLinc - South Bend (Medical)

    • Federally Qualified Health Center (FQHC)
    • South Bend, IN
    • NPI 1790158244

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc
    • Federally Qualified Health Center (FQHC)
    • Knox, IN
    • NPI 1801063268

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc
    • Federally Qualified Health Center (FQHC)
    • South Bend, IN
    • NPI 1811465602

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc
    • Federally Qualified Health Center (FQHC)
    • South Bend, IN
    • NPI 1972071769

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc.

    dba HealthLinc - East Chicago

    • Federally Qualified Health Center (FQHC)
    • East Chicago, IN
    • NPI 1184069569

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc.
    • Federally Qualified Health Center (FQHC)
    • Mishawaka, IN
    • NPI 1417244989

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc.

    dba HealthLinc - South Bend Dental

    • Federally Qualified Health Center (FQHC)
    • South Bend, IN
    • NPI 1679954804

    5% Or Greater Direct Ownership Interest

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1063256626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 BROADWAY ST",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463122218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 BROADWAY ST",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463122218",
            "telephone_number": "219-413-5118",
            "fax_number": "219-200-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHLINC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "D",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthLinc - East Chicago Harbor West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Chicago, IN

Sources for this page

Verify at the official NPI Registry.