NPIMap

Organization Active NPI

Upper Great Lakes Family Health Center

Doing business as Marquette Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Marquette, MI
National Provider Identifier
1053948265
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Doing business as
Marquette Family Health Center
Practice address
1414 W Fair Ave Ste 249
Marquette, MI 49855-5406
Phone
(906) 449-2900
Fax
(906) 372-3230
NPI assigned
Mar 26, 2020
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
-As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Authorized official

Name
Trevor Hodges
Title
Ceo
Phone
(906) 483-1846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1414 W Fair Ave Ste 249
Marquette, MI 49855-5406

Mailing address

135 E M35
Gwinn, MI 49841-9160
Phone (906) 449-2900

Other names 1

  • Marquette Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100629000853 MI Part B Supplier - Clinic/Group Practice 1951432384 Receives reassigned benefits from 63 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Menominee, MI; Marquette, MI; Gwinn, MI; Iron River, MI; East Lansing, MI; Calumet, MI; Hancock, MI
O20200416003542 MI Part A Provider - Federally Qualified Health Center (FQHC) 1951432384 Practice locations: Marquette, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053948265. Details of each certification follow.

Federally qualified health center certification: CCN 231160

Legal name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Doing business as
MARQUETTE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 24, 2020
Last certification
Apr 24, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1414 W Fair Ave
Ste 249
Marquette, MI 49855-5406

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
23D2184332Upper Great Lakes Marquette Family Health Center1414 W Fair Avenue Suite 249, Marquette, MI 49855Certificate of waiverMay 18, 2028

National Provider Directory

National Provider Directory
Part of
Upper Great Lakes Center

Locations

506 Campus Dr
Hancock, MI 49930
Phone (906) 483-1000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JIJCAD

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tanya Johnson Individual Corporate OfficerBoard Member Oct 28, 2020
Trevor Hodges Individual Corporate DirectorCeo Jul 1, 2025
W-2 Managing EmployeeCeo Jul 1, 2025
Mark Rouleau Individual Corporate OfficerBoard Member Nov 24, 2021
Michael Hagwell Individual Corporate DirectorCfo Apr 30, 2025
W-2 Managing EmployeeAd;Cfo Apr 30, 2025
Kevin L Piggott Individual Corporate OfficerBoard Member Oct 31, 2018
Dianna Christenson Individual Corporate OfficerBoard Member Dec 4, 2013
Julie Shaw Individual Corporate OfficerBoard Member Sep 25, 2019
Micah Stipech Individual Corporate OfficerBoard Member Mar 25, 2020
Bailey Patrick Individual Corporate DirectorCoo Jan 3, 2022
W-2 Managing EmployeeCoo Jan 3, 2022

Practitioners & affiliated clinicians

Practitioners 5

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": "1585180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1053948265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 E M35",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498419160",
            "telephone_number": "906-449-2900",
            "fax_number": "906-372-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 249",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555406",
            "telephone_number": "906-449-2900",
            "fax_number": "906-372-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER GREAT LAKES FAMILY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "-",
        "enumeration_date": "2020-03-26",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "906-483-1846"
    },
    "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": "Marquette Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marquette Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marquette, MI

Sources for this page

Verify at the official NPI Registry.