NPIMap

Organization Active NPI

Healthlinc, Inc

Doing business as HealthLinc -East Chicago Harbor

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
National Provider Identifier
1508433707
Registry record updated Jan 12, 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
Practice address
2323 Broadway St.
East Chicago, IN 46312
Phone
(888) 580-1060
NPI assigned
Jun 7, 2021
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTHLINC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

2323 Broadway St.
East Chicago, IN 46312

Mailing address

2401 Valley Dr
Valparaiso, IN 46383-2520

Other names 1

  • HealthLinc -East Chicago Harbor 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…
O20210615000774 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 1508433707. Details of each certification follow.

Federally qualified health center certification: CCN 151108

Legal name
HEALTHLINC INC
Doing business as
HEALTHLINC -EAST CHICAGO HARBOR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2021
Last certification
Jun 14, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 31, 2001 in IN
Enrollment address
2323 Broadway St
East Chicago, IN 46312-2264

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
Tax ID family
Healthlinc Inc19 organizations share this tax ID, including this one
Part of
Healthlinc Inc

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

2323 Broadway St
Healthlinc E Chicago
East Chicago, IN 46312

200 Alfred St
#300
Michigan City, IN 46360

710 Franklin St
Michigan City, IN 46360
Phone (219) 262-1800

1708 High St
Ste 300
South Bend, IN 46613

1960 Northside Blvd
South Bend, IN 46615
Phone (574) 231-7228

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
Jesus Cervera Individual Corporate Director Oct 1, 2013
Clarence Gehrke Individual Corporate Director Oct 1, 2013
Debra Williams Individual Corporate Director Oct 1, 2013
Dorian Bush Individual Corporate Director Jun 21, 2010
Ivan Bodensteiner Individual Corporate Director Oct 1, 2007
Casaundra M Hill Individual Corporate Director May 20, 2013
Beth Wrobel Individual Corporate OfficerCeo Oct 1, 2007
W-2 Managing EmployeeCeo Oct 1, 2007
Operational/Managerial ControlCeo Oct 1, 2007
Christine Atherton Individual Corporate Director Jun 21, 2010
John Gornto Individual Corporate Director Jun 21, 2010
Donnita Scully Individual Corporate Director Jun 21, 2010

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1508433707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 VALLEY DR",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 BROADWAY ST.",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "46312",
            "telephone_number": "888-580-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHLINC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHLINC, INC",
        "enumeration_date": "2021-06-07",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MELISSA",
        "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",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthLinc -East Chicago Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Chicago, IN

Sources for this page

Verify at the official NPI Registry.