NPIMap

Organization Active NPI

219 Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
National Provider Identifier
1366083776
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
2020 E Columbus Dr Ste a
East Chicago, IN 46312-2830
Phone
(219) 397-8965
Fax
(219) 397-9351
NPI assigned
Oct 7, 2019
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 1

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

Addresses

Primary practice location

2020 E Columbus Dr Ste a
East Chicago, IN 46312-2830

Mailing address

100 W Chicago Ave Ste F
East Chicago, IN 46312-3261
Phone (219) 703-2583

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191015000094 IN Part A Provider - Federally Qualified Health Center (FQHC) 0547521452 Practice locations: East Chicago, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366083776. Details of each certification follow.

Federally qualified health center certification: CCN 151065

Legal name
219 HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 15, 2019
Last certification
Oct 15, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 27, 2017 in IN
Enrollment address
2020 E Columbus Dr
Ste a
East Chicago, IN 46312-2830

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 DirectorBoard Member May 1, 2018
William Cortes Individual Corporate OfficerExecutive Director Mar 31, 2024
W-2 Managing EmployeeExecutive Director Mar 31, 2024
Gloria Vela Individual Corporate DirectorBoard Member May 1, 2018
Marjol Rush-Collet Individual Corporate DirectorBoard Member May 1, 2018
Leo Correa Individual Corporate DirectorBoard Chair May 1, 2018
Sandra Noe Individual Corporate DirectorBoard Member May 1, 2018
Sava Pavkovich Individual Corporate DirectorDirector Oct 26, 2022
Milton Reed Individual Corporate DirectorBoard Member May 1, 2018
Sara Jiminez Individual Corporate DirectorBoard Member May 1, 2018
Martha Gonzalez Individual Corporate DirectorDirector Oct 26, 2022

Practitioners & affiliated clinicians

Practitioners 1

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": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1366083776",
    "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": "219-703-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 E COLUMBUS DR STE A",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463122830",
            "telephone_number": "219-397-8965",
            "fax_number": "219-397-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Chicago, IN

Sources for this page

Verify at the official NPI Registry.