NPIMap

Organization Active NPI

Northshore Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
National Provider Identifier
1336992999
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHSHORE HEALTH CENTERS, INC.
Practice address
2121 E Columbus Dr
East Chicago, IN 46312-3197
Phone
(219) 763-8112
Fax
(219) 764-5380
NPI assigned
Apr 11, 2024
Last updated
Apr 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Authorized official

Name
Rhona Gilliam
Title
Contracting Specialist
Phone
(219) 763-8112

Specialties & licenses 1

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

Addresses

Primary practice location

2121 E Columbus Dr
East Chicago, IN 46312-3197

Mailing address

PO Box 1430
Portage, IN 46368-9230

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040827000220 IN Part B Supplier - Clinic/Group Practice 5799671236 Receives reassigned benefits from 128 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Station, IN; Merrillville, IN; Michigan City, IN; Portage, IN; Saint John, IN; Crown Point, IN; Schererville, IN; Valparaiso, IN…
O20240530001439 IN Part A Provider - Federally Qualified Health Center (FQHC) 5799671236 Practice locations: East Chicago, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336992999. Details of each certification follow.

Federally qualified health center certification: CCN C51039

Legal name
NORTHSHORE HEALTH CENTERS INC
Doing business as
NORTHSHORE EAST CHICAGO HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 28, 2024
Last certification
May 28, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1997 in IN
Enrollment address
2121 E Columbus Dr
East Chicago, IN 46312-3197

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 24

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

View all 24

National Provider Directory

National Provider Directory

Locations

1008 Broadway
Chesterton, IN 46304
Phone (219) 728-1638

407 W Indiana Ave
Chesterton, IN 46304
Phone (219) 712-3875

651 W Morgan Ave
Rm F168
Chesterton, IN 46304

801 Broadway
Chesterton, IN 46304
Phone (219) 764-5311

10851 Broadway
Ste N
Crown Point, IN 46307

1275 E North St
Ste 102
Crown Point, IN 46307
Phone (219) 922-8051

310 W 112th Ave
Crown Point, IN 46307
Phone (219) 763-8113

2121 E Columbus Dr
East Chicago, IN 46312
Phone (219) 397-6300

600 N Wiggs St
Rm A
Griffith, IN 46319

6920 Indianapolis Blvd
Hammond, IN 46324

602 F St
Rm G
La Porte, IN 46350

2580 Central Ave
Lake Station, IN 46405

3304 Parkside Ave
Lake Station, IN 46405
Phone (219) 962-8531

714 Lincolnway
Laporte, IN 46350
Phone (219) 763-8812

6091 Broadway
Merrillville, IN 46410

8555 Taft St
Merrillville, IN 46410
Phone (219) 736-7232

9825 Wicker Ave
Saint John, IN 46373

9825 Wicker Ave
Side
Saint John, IN 46373

1515 US Highway 41
Schererville, IN 46375

1515 US Highway 41
Ste W
Schererville, IN 46375

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Steven C Disney Individual Corporate OfficerBoard Member Dec 18, 2018
David Hall Individual Corporate OfficerCeo Jan 23, 2020
W-2 Managing EmployeeCeo Jan 23, 2020
Roman Bronson Individual Corporate OfficerTreasurer Apr 28, 2020
Thomas Mosley Individual Corporate OfficerVice Chairman Dec 18, 2018
Scott V Cherry Individual Corporate OfficerBoard Member Aug 1, 2011
Denneese Concepcion Individual Corporate OfficerBoard Member Jun 26, 2018
Scott E Fritz Individual Corporate OfficerBoard Member Dec 1, 2013
Thomas Cripliver Individual Corporate OfficerBoard Member Feb 25, 2020
Wilma Vazquez Individual Corporate OfficerBoard Member Sep 16, 2016
Lauren Trumbo Individual Corporate OfficerChairman Dec 18, 2018
Connie Rudd Individual Corporate OfficerBoard Member Aug 1, 2011
Jena Bellezza Individual Corporate OfficerBoard Member Sep 16, 2016
Tom Aldrich Individual Corporate OfficerBoard Member Dec 18, 2018

Practitioners & affiliated clinicians

Practitioners 147

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.

View all 147

NPI Registry JSON

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1336992999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1430",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463689230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E COLUMBUS DR",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123197",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "RHONA",
        "authorized_official_title_or_position": "CONTRACTING SPECIALIST",
        "authorized_official_telephone_number": "219-763-8112"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Chicago, IN

Sources for this page

Verify at the official NPI Registry.