Healthlinc, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · South Bend, IN
NPI 1679954804 · NPPES record last updated Jan 12, 2024
Key facts
- NPI
- 1679954804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- HEALTHLINC, INC.
- Practice address
- 1002 S Esther St
South Bend, IN 46615 - Phone
- (219) 477-6082
- Fax
- (219) 465-9502
- NPI assigned
- Jun 12, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- HEALTHLINC, INC.
Authorized official
- Name
- Melissa Mitchell
- Title
- Ceo
- Phone
- (219) 465-9503
Owners & managing parties with NPI records 15
Owned or controlled facilities with NPI records 7
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 14
Corporate family (same tax ID) 14
Facilities with the same owner 7
Practitioners 90
-
Melissa J Quiroz, LMHC
-
Sayf Al-Khazraji, OD
-
Joshua Daniel Avery, FNP-BC
-
Jennifer Marie Beam, FNP
-
Lilia Ivette Bonilla, FNP
-
Melissa Brewster, LMHC, NCC.
-
Lisa Marie Budka, RN, NP-C
-
Ceara Burton, FNP-C
-
John Douglas Busch, D.C.
-
Brooke V Butler, FNP
-
Rylee Cartales, FNP-C
-
April Christine Chew, DNP, APRN, FNP-BC
-
Elizabeth Clark, NCC, LMHCA
-
Joseph A Dejoan, M.D.
-
Damian D Dieter, DPM
-
Kari L Evans, FNP
-
Karen Fagan, APN
-
Sarah Feeler, NP
-
Nicole Ford, NP
-
Taylor Freedline, FNP-BC
-
Diana Garcia Burns, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
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
- Corporation · Non-profit
- Incorporated
- May 31, 2001 in IN
- Enrollment address
- 1002 S Esther St
South Bend, IN 46615-1440
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Shery a Roussarie |
Corporate Director | Sep 21, 2020 | |
| Susan Thorner |
Corporate Director | May 16, 2022 | |
| Sandra Goldberg |
Corporate Director | Nov 1, 2023 | |
| Robert Franko |
Corporate Director |
Sep 16, 2019 | |
| Chanthini Fowler |
Corporate Director | May 16, 2022 | |
| Stephen Massa |
Corporate Director | Oct 21, 2019 | |
| Christopher C Jordan |
Corporate Director | May 15, 2023 | |
| Healthlinc Inc |
5% Or Greater Direct Ownership Interest | May 31, 2001 | 100% |
| David Pearman |
Corporate Director | May 16, 2022 | |
| Christine Atherton |
Corporate Director | Jun 19, 2017 | |
| Melissa Mitchell |
Corporate Director |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Jennifer Stall |
Corporate Director | Jan 17, 2023 | |
| Patricia Terrell |
Corporate Director | Jun 18, 2018 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Healthlinc - Knox |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 31, 2001 |
| Healthlinc - Mishawaka |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 31, 2011 |
| Healthlinc - East Chicago |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 31, 2001 |
| Healthlinc - South Bend (Medical) |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 31, 2001 |
| Healthlinc - Centennial |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 31, 2001 |
| Healthlinc - Southeast |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Nov 19, 2018 |
| Healthlinc Laporte |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | May 31, 2001 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Healthlinc Inc
- Part of
- Healthlinc Inc
Locations
400 Teegarden St
Laporte, IN 46350
Phone (219) 326-0043
710 Franklin St
Ste 200
Michigan City, IN 46360
Phone (219) 872-6200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 193380 | Other | IN | MEDICARE |
| 200317310G | Medicaid | IN |
Other names
- HealthLinc - South Bend Dental
Other providers in South Bend, IN
- Health Plus Indiana
- Health Plus Indiana
- Healthlinc, Inc
- Healthlinc, Inc
- Healthlinc, Inc
- Healthlink LLC
- Healthy Pathways Counseling LLC
- Healthy U RX Inc.
- Healthy U RX Inc.
- Healthy U RX Inc.
All providers in South Bend, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.