NPIMap

Organization Active NPI

219 Health Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Munster, IN
National Provider Identifier
1821771874
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
1946 45TH St
Ste D
Munster, IN 46321-3986
Phone
(219) 924-1888
Fax
(219) 922-8359
NPI assigned
Aug 8, 2023
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Women's Health Nurse Practitioner 363LW0102X NU

Addresses

Primary practice location

1946 45TH St
Ste D
Munster, IN 46321-3986

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
O20240318001342 IN Part A Provider - Federally Qualified Health Center (FQHC) 0547521452 Practice locations: Munster, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821771874. Details of each certification follow.

Federally qualified health center certification: CCN C51022

Legal name
219 HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2024
Last certification
Mar 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1946 45TH St
Ste D
Munster, IN 46321-3956

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
15D0713144219 Health Network, Inc - Community Care Center1946 45TH St, Munster, IN 46321Provider-performed microscopyJan 1, 2028

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 Jul 25, 2018
William Cortes Individual Corporate DirectorExecutive Director Mar 31, 2024
W-2 Managing EmployeeExecutive Director Mar 31, 2024
Gloria Vela Individual Corporate DirectorDirector Apr 9, 2018
Marjol Rush-Collet Individual Corporate DirectorDirector Apr 9, 2018
Leo Correa Individual Corporate DirectorChairman Jul 25, 2018
Sandra Noe Individual Corporate DirectorDirector Aug 30, 2023
Sava Pavkovich Individual Corporate DirectorSecretary Aug 30, 2023
Milton Reed Individual Corporate DirectorDirector Apr 9, 2018
Sara Jiminez Individual Corporate DirectorDirector Dec 18, 2018
Martha Gonzalez Individual Corporate DirectorDirector Oct 26, 2022

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": "1691452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1821771874",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1946 45TH ST",
            "address_2": "STE D",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213986",
            "telephone_number": "219-924-1888",
            "fax_number": "219-922-8359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "219 HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-08",
        "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": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.