NPIMap

Organization Active NPI

219 Health Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cedar Lake, IN
National Provider Identifier
1669104964
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
13963 Morse St Ste B
Cedar Lake, IN 46303-9639
Phone
(219) 374-5555
Fax
(219) 374-6669
NPI assigned
Jun 27, 2022
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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

13963 Morse St Ste B
Cedar Lake, IN 46303-9639

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
O20220912002527 IN Part A Provider - Federally Qualified Health Center (FQHC) 0547521452 Practice locations: Cedar Lake, IN

Federally qualified health center certification: CCN 151148

Legal name
219 HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 2022
Last certification
Sep 12, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
13963 Morse St
Ste B
Cedar Lake, IN 46303-9639

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
15D0677545219 Health Network, Inc13963 Morse St, Cedar Lake, IN 46303Certificate of waiverOct 31, 2026

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 DirectorTreasurer May 1, 2018
William Cortes Individual Corporate DirectorExecutive Director Mar 31, 2024
W-2 Managing EmployeeExecutive Director Mar 31, 2024
Gloria Vela Individual Corporate DirectorDirector May 1, 2018
Marjol Rush-Collet Individual Corporate DirectorDirector May 1, 2018
Constantina Mourtos Individual Corporate DirectorDirector Feb 26, 2020
Andrea Sherwin Individual Corporate DirectorDirector Nov 1, 2020
Leo Correa Individual Corporate DirectorChairman May 1, 2018
Sandra Noe Individual Corporate DirectorDirector May 1, 2018
Milton Reed Individual Corporate DirectorDirector May 1, 2018
Sara Jiminez Individual Corporate DirectorDirector May 1, 2018

NPI Registry JSON

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

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1669104964",
    "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": "219-392-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13963 MORSE ST STE B",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463039639",
            "telephone_number": "219-374-5555",
            "fax_number": "219-374-6669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-27",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Lake, IN

Sources for this page

Verify at the official NPI Registry.