NPIMap

Organization Active NPI

219 Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
National Provider Identifier
1578025896
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
4320 First Street
Suite 211
East Chicago, IN 46312
Phone
(219) 703-2577
Fax
(219) 703-6679
NPI assigned
Apr 4, 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

4320 First Street
Suite 211
East Chicago, IN 46312

Mailing address

100 W Chicago Ave Ste F
East Chicago, IN 46312-3261
Phone (219) 365-7620

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190416000191 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 1578025896. Details of each certification follow.

Federally qualified health center certification: CCN 151048

Legal name
219 HEALTH NETWORK INC
Doing business as
219 HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2019
Last certification
Apr 16, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 27, 2017 in IN
Enrollment address
4320 Fir St
Unit 211
East Chicago, IN 46312-3076

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

Locations

4320 Fir St
Unit 211
East Chicago, IN 46312
Phone (219) 703-2577

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

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
Reginald Jones Individual Corporate DirectorBoard Member May 1, 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 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
Paige McNulty Individual Corporate DirectorBoard Member May 1, 2018
Milton Reed Individual Corporate DirectorBoard Member May 1, 2018
Sara Jiminez Individual Corporate DirectorBoard Member May 1, 2018

Practitioners & affiliated clinicians

Practitioners 2

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": "1554336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1578025896",
    "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": "219-365-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 FIRST STREET",
            "address_2": "SUITE 211",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "46312",
            "telephone_number": "219-703-2577",
            "fax_number": "219-703-6679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-04",
        "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.