Individual provider Active NPI

Debra A Zack, DO

  • Family Medicine Physician
  • Michigan City, IN
National Provider Identifier
1750362901
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02001389A Issued in IN
Practice address
200 Alfred St
Michigan City, IN 46360
Phone
(219) 872-6200
Fax
(219) 879-2915
NPI assigned
Nov 7, 2005
Last updated
Mar 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02001389 IN
Family Medicine Physician 207Q00000X 02001389A IN Primary

Addresses

Primary practice location

200 Alfred St
Michigan City, IN 46360

Mailing address

710 Franklin St Ste 200
Michigan City, IN 46360-3564
Phone (219) 872-6200

Other identifiers 1

IdentifierTypeStateIssuer
100366040MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address debra.zack@healthlinc.directbygreenway.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100423000389 IN Practitioner - Family Practice 0143357079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthlinc IncGroup PAC ID 7618929373, 83 clinicians

Practice addresses (Care Compare)

1001 Sturdy Rd
Valparaiso, IN 46383-4126
Phone 21946271732226

200 Alfred St
Michigan City, IN 46360-3563
Phone (219) 872-6200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02001389INMDFamily Medicine Physician
02001389AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthlinc, Inc. CurrentSince Sep 16, 2017 Accepting new patients
Healthlinc, Inc. Current Accepting new patients
Healthlinc, Inc CurrentSince Sep 16, 2017 Accepting new patients

Locations

200 Alfred St
Michigan City, IN 46360
Phone (219) 224-2626

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

710 Franklin St
Ste 200
Michigan City, IN 46360
Phone (219) 872-6200

1001 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 462-7173

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

Interoperability endpoints

  • Direct secure messaging: dzack384013@direct.franciscanalliance.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1750362901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 FRANKLIN ST STE 200",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463603564",
            "telephone_number": "219-872-6200",
            "fax_number": "219-879-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ALFRED ST",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "46360",
            "telephone_number": "219-872-6200",
            "fax_number": "219-879-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACK",
        "first_name": "DEBRA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001389",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001389A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100366040",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "debra.zack@healthlinc.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "710 Franklin St Ste 200",
            "city": "Michigan City",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463603564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Michigan City, IN

Sources for this page

Verify at the official NPI Registry.