NPIMap

Organization Active NPI

Healthlinc, Inc.

Doing business as HealthLinc - South Bend Dental

  • Federally Qualified Health Center (FQHC)
  • South Bend, IN
National Provider Identifier
1679954804
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 - South Bend Dental
Practice address
1002 S Esther St
South Bend, IN 46615
Phone
(219) 477-6082
Fax
(219) 465-9502
NPI assigned
Jun 12, 2015
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTHLINC, INC.As 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

1002 S Esther St
South Bend, IN 46615

Mailing address

2401 Valley Dr
Valparaiso, IN 46383-2520
Phone (219) 413-5100

Other names 1

  • HealthLinc - South Bend Dental 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…
O20150814014686 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618929373 Practice locations: South Bend, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679954804. Details of each certification follow.

Federally qualified health center certification: CCN 151952

Legal name
HEALTHLINC INC
Doing business as
HEALTHLINC - IUSB DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 14, 2015
Last certification
Aug 14, 2015
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 31, 2001 in IN
Enrollment address
1002 S Esther St
South Bend, IN 46615-1440

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

1313 W Chicago Ave
East Chicago, IN 46312
Phone (219) 397-1196

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
Shery a Roussarie Individual Corporate Director Sep 21, 2020
Susan Thorner Individual Corporate Director May 16, 2022
Sandra Goldberg Individual Corporate Director Nov 1, 2023
Robert Franko Individual Corporate DirectorDirector Sep 16, 2019
Chanthini Fowler Individual Corporate Director May 16, 2022
Stephen Massa Individual Corporate Director Oct 21, 2019
Christopher C Jordan Individual Corporate Director May 15, 2023
Healthlinc Inc Organization, South Bend, IN Non-profit 5% Or Greater Direct Ownership Interest May 31, 2001 100%
David Pearman Individual Corporate Director May 16, 2022
Christine Atherton Individual Corporate Director Jun 19, 2017
Melissa Mitchell Individual Corporate DirectorCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024
Jennifer Stall Individual Corporate Director Jan 17, 2023
Patricia Terrell Individual Corporate Director Jun 18, 2018

Owners & managing parties with NPI records 15

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Healthlinc, Inc

    dba HealthLinc - East Chicago Harbor West

    • Federally Qualified Health Center (FQHC)
    • East Chicago, IN
    • NPI 1063256626

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc

    dba HealthLinc -East Chicago Harbor

    • Federally Qualified Health Center (FQHC)
    • East Chicago, IN
    • NPI 1508433707

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc
    • Federally Qualified Health Center (FQHC)
    • La Porte, IN
    • NPI 1538728399

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc
    • Federally Qualified Health Center (FQHC)
    • La Porte, IN
    • NPI 1538980990

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc

    dba HealthLinc - Newton

    • Federally Qualified Health Center (FQHC)
    • Morocco, IN
    • NPI 1568354116

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Healthlinc, Inc

    dba Healthlinc - Corporate

    • Federally Qualified Health Center (FQHC)
    • Valparaiso, IN
    • NPI 1578293452

    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.
    • Federally Qualified Health Center (FQHC)
    • Michigan City, IN
    • NPI 1013105568

    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
View all 15

All facility ownership & control disclosures 7

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 - 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 7

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 8

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": "1434067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1679954804",
    "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",
            "telephone_number": "219-413-5100",
            "fax_number": "219-465-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 S ESTHER ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46615",
            "telephone_number": "219-477-6082",
            "fax_number": "219-465-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHLINC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHLINC, INC.",
        "enumeration_date": "2015-06-12",
        "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 - South Bend Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthLinc - South Bend Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.