NPIMap

Organization Active NPI

Healthlinc, Inc

  • Federally Qualified Health Center (FQHC)
  • South Bend, IN
National Provider Identifier
1972071769
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
Practice address
621 Memorial Dr Ste 402
South Bend, IN 46601-1074
Phone
(219) 413-5100
Fax
(219) 465-9507
NPI assigned
Nov 9, 2018
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTHLINC, INCAs 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 NU Primary

Addresses

Primary practice location

621 Memorial Dr Ste 402
South Bend, IN 46601-1074

Mailing address

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

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…
O20181121000396 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 1972071769. Details of each certification follow.

Federally qualified health center certification: CCN 151025

Legal name
HEALTHLINC INC
Doing business as
HEALTHLINC - CENTENNIAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 19, 2018
Last certification
Nov 19, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 31, 2001 in IN
Enrollment address
621 Memorial Dr
Ste 402
South Bend, IN 46601-1074

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 Inc15 organizations share this tax ID, including this one
Part of
Healthlinc Inc

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

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

2323 Broadway St
East Chicago, IN 46312

1960 Northside Blvd
South Bend, IN 46615
Phone (574) 231-7228

621 Memorial Dr
Ste 402
South Bend, IN 46601
Phone (574) 232-4800

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 Director 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, Valparaiso, 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 Officer Jun 19, 2017
Melissa Mitchell Individual Corporate DirectorCeo Jan 1, 2024
W-2 Managing Employee 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)
    • 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
  • Healthlinc, Inc.
    • Federally Qualified Health Center (FQHC)
    • Mishawaka, IN
    • NPI 1417244989

    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 - Iusb DentalSouth Bend, IN, CCN 151952 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 - 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.

    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
  • Healthlinc, Inc.

    dba HealthLinc - South Bend Dental

    • Federally Qualified Health Center (FQHC)
    • South Bend, IN
    • NPI 1679954804

    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 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1972071769",
    "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": "219-465-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEMORIAL DR STE 402",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011074",
            "telephone_number": "219-413-5100",
            "fax_number": "219-465-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHLINC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHLINC, INC",
        "enumeration_date": "2018-11-09",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.