Upper Great Lakes Family Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Gwinn, MI
NPI 1104158690 · NPPES record last updated May 13, 2026
Key facts
- NPI
- 1104158690
- 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
- 135 East M 35
Gwinn, MI 49841-9159 - Phone
- (906) 346-9275
- Fax
- (906) 372-3230
- NPI assigned
- Feb 8, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Trevor Hodges
- Title
- Ceo
- Phone
- (906) 483-1846
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 11
Practitioners 43
-
Kathryn S Kurtz, LMSW
-
Mercedes A Maki, PA
-
Emily Starr, NP-C
-
Mitzi Colleen Amelon, D.O.
-
Ashley E Croasdell, FNP
-
Ericka Marie Distefano, FNP, ACUPUNCTURIST
-
Catherine A Kroll, D.O.
-
Leah Abbott, MD
-
Mabel A Adams, PA-C
-
Zainab Almahrous, MD
-
Kay Susan Baranczyk, APNP
-
Devyn Dempsey, DO
-
Karen Marie Deyoung, D.O.
-
Danielle Hamlin, NP
-
Diana J Hardy, P.A.
-
Melissa Kristine Hinkhouse, PMHNP-BC
-
Jennifer Lynn Huls, NP-C
-
Rosmin C Jos, MD, MPH
-
Kathryn E Kass, PA
-
Thomas Kates, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0382083 | Gwinn Family Health Center | Certificate of waiver | Dec 27, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Federally qualified health center certification: CCN 231954
- Legal name
- UPPER GREAT LAKES FAMILY HEALTH CENTER
- Doing business as
- GWINN FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 30, 2011
- Last certification
- Mar 30, 2011
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 1, 2013 in MI
- Enrollment address
- 135 E M35
Gwinn, MI 49841-9160
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Tanya Johnson |
Corporate Officer | Oct 28, 2020 | |
| Trevor Hodges |
Corporate Director |
Jan 1, 2021 | |
| W-2 Managing Employee |
Jan 1, 2021 | ||
| Mark Rouleau |
Corporate Officer | Nov 24, 2021 | |
| Stephen Vairo |
Corporate Director |
Sep 1, 2013 | |
| Donald Simila |
Corporate Director |
Dec 1, 2010 | |
| W-2 Managing Employee |
Dec 1, 2010 | ||
| Kevin L Piggott |
Corporate Officer | Oct 31, 2018 | |
| Cathryn Beer |
Corporate Officer | Oct 26, 2016 | |
| Dianna Christenson |
Corporate Officer |
Sep 1, 2013 | |
| Christopher Adams |
Corporate Officer | Jun 26, 2019 | |
| Julie Shaw |
Corporate Director |
Sep 1, 2013 | |
| Allen Mott |
Corporate Officer | Mar 28, 2018 | |
| Micah Stipech |
Corporate Officer | Mar 25, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20110315000166 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 1951432384 | Practice locations: Gwinn, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | MI | Yes |
Addresses
Primary practice location
135 East M 35
Gwinn, MI 49841-9159
Mailing address
135 E M35
Gwinn, MI 49841-9160
Phone (906) 346-9275
Other names
- Gwinn Family Health Center
Other providers in Gwinn, MI
- Rell Drake Spickerman
- Emily Starr
- Kimberley Ann Suhanic
- Township of Forsyth
- Autumn M Trudeau
- Upper Great Lakes Family Health Center
- Upper Great Lakes Family Health Center
- Upper Great Lakes Family Health Center
- Denise Marie Usher
- James Edward Vereb
All providers in Gwinn, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.