NPIMap

Organization Active NPI

219 Health Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hobart, IN
National Provider Identifier
1265148498
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
1356 S Lake Park Ave
Hobart, IN 46342-5964
Phone
(219) 836-1310
Fax
(219) 836-0617
NPI assigned
Jan 31, 2023
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Rheumatology Physician 207RR0500X NU

Addresses

Primary practice location

1356 S Lake Park Ave
Hobart, IN 46342-5964

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
O20230206001855 IN Part A Provider - Federally Qualified Health Center (FQHC) 0547521452 Practice locations: Hobart, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265148498. Details of each certification follow.

Federally qualified health center certification: CCN 151167

Legal name
219 HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 2, 2023
Last certification
Feb 2, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 27, 2017 in IN
Enrollment address
1356 S Lake Park Ave
Hobart, IN 46342-5964

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0677901219 Health Network, Inc1356 S Lake Park Ave, Hobart, IN 46342Certificate of waiverMay 7, 2027

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 12

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 Director May 1, 2018
Gloria Vela Individual Corporate Director May 1, 2018
Marjol Rush-Collet Individual Corporate Director May 1, 2018
Constantina Mourtos Individual Corporate Director Feb 26, 2020
Andrea Sherwin Individual Corporate Director Nov 1, 2020
Leo Correa Individual Corporate Director May 1, 2018
Sandra Noe Individual Corporate Director May 1, 2018
Patricia a Johnson Individual Corporate Officer Feb 24, 2021
W-2 Managing Employee Feb 24, 2021
Sava Pavkovich Individual Corporate Director Oct 26, 2022
Milton Reed Individual Corporate Director May 1, 2018
Sara Jiminez Individual Corporate Director May 1, 2018
Martha Gonzalez Individual Corporate Director Oct 26, 2022

Practitioners & affiliated clinicians

Practitioners 4

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": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1265148498",
    "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",
            "fax_number": "219-397-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463425964",
            "telephone_number": "219-836-1310",
            "fax_number": "219-836-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobart, IN

Sources for this page

Verify at the official NPI Registry.