NPIMap

Organization Active NPI

219 Health Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Saint John, IN
National Provider Identifier
1245913342
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
9660 Wicker Ave Ste 2a
Saint John, IN 46373-9487
Phone
(219) 226-2244
Fax
(219) 703-6860
NPI assigned
Aug 8, 2023
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

9660 Wicker Ave Ste 2a
Saint John, IN 46373-9487

Mailing address

100 W Chicago Ave Ste F
East Chicago, IN 46312-3261
Phone (219) 392-7016

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240214000313 IN Part A Provider - Federally Qualified Health Center (FQHC) 0547521452 Practice locations: Saint John, IN

Federally qualified health center certification: CCN C51017

Legal name
219 HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 1, 2024
Last certification
Feb 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
9660 Wicker Ave
Ste 2a
Saint John, IN 46373-9487

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

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 DirectorTreasurer Jul 25, 2018
William Cortes Individual Corporate DirectorExecutive Director Mar 31, 2024
W-2 Managing EmployeeExecutive Director Mar 31, 2024
OtherExecutive Director Mar 31, 2024
Gloria Vela Individual Corporate DirectorDirector Apr 9, 2018
Marjol Rush-Collet Individual Corporate DirectorDirector Apr 9, 2018
Leo Correa Individual Corporate DirectorChairman Jul 25, 2018
Sandra Noe Individual Corporate DirectorDirector Jul 25, 2018
Sava Pavkovich Individual Corporate DirectorDirector Oct 26, 2022
Milton Reed Individual Corporate DirectorDirector Apr 9, 2018
Sara Jiminez Individual Corporate DirectorDirector Dec 18, 2018
Martha Gonzalez Individual Corporate DirectorDirector Oct 26, 2022

NPI Registry JSON

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1245913342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W CHICAGO AVE STE F",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123261",
            "telephone_number": "219-392-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9660 WICKER AVE STE 2A",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739487",
            "telephone_number": "219-226-2244",
            "fax_number": "219-703-6860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-08",
        "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": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Saint John, IN

Sources for this page

Verify at the official NPI Registry.