NPIMap

Upper Great Lakes Family Health Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Marquette, MI

NPI 1053948265 · NPPES record last updated May 13, 2026

Key facts

NPI
1053948265
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
UPPER GREAT LAKES 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
Organization subpart
Yes
Parent organization (as reported)
-

Authorized official

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

Other NPIs on the same Medicare enrollment 10

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

Other NPIs with the same Medicare PAC ID 11

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

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 41

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2184332Upper Great Lakes Marquette Family Health Center
1414 W Fair Avenue Suite 249, Marquette, MI 49855		Certificate of waiverMay 18, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

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
Corporation · Non-profit
Enrollment address
1414 W Fair Ave
Ste 249
Marquette, MI 49855-5406

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 Officer
Board Member		 Oct 28, 2020
Trevor Hodges
Individual 		Corporate Director
Ceo		 Jul 1, 2025
W-2 Managing Employee
Ceo		 Jul 1, 2025
Mark Rouleau
Individual 		Corporate Officer
Board Member		 Nov 24, 2021
Michael Hagwell
Individual 		Corporate Director
Cfo		 Apr 30, 2025
W-2 Managing Employee
Ad;Cfo		 Apr 30, 2025
Kevin L Piggott
Individual 		Corporate Officer
Board Member		 Oct 31, 2018
Dianna Christenson
Individual 		Corporate Officer
Board Member		 Dec 4, 2013
Julie Shaw
Individual 		Corporate Officer
Board Member		 Sep 25, 2019
Micah Stipech
Individual 		Corporate Officer
Board Member		 Mar 25, 2020
Bailey Patrick
Individual 		Corporate Director
Coo		 Jan 3, 2022
W-2 Managing Employee
Coo		 Jan 3, 2022

Medicare enrollment records

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

National Provider Directory

Part of
Upper Great Lakes Center

Locations

1414 W Fair Ave
Ste 249
Marquette, MI 49855
Phone (906) 225-3333

Interoperability endpoints

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

Specialties & licenses

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

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

  • Marquette Family Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 13, 2026.

{
    "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

All providers in Marquette, MI · Federally Qualified Health Center (FQHC) in Michigan

Sources for this page

Verify at the official NPI Registry.