NPIMap

Organization Active NPI

Upper Great Lakes Family Health Center

Doing business as Gwinn Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Gwinn, MI
National Provider Identifier
1104158690
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
Gwinn 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
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

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
Mr. Trevor Hodges
Title
Ceo
Phone
(906) 483-1846

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X MI Primary

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 1

  • Gwinn 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
O20110315000166 MI Part A Provider - Federally Qualified Health Center (FQHC) 1951432384 Practice locations: Gwinn, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104158690. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 1, 2013 in MI
Enrollment address
135 E M35
Gwinn, MI 49841-9160

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
23D0382083Gwinn Family Health Center135 E M-35, Gwinn, MI 49841Certificate of waiverDec 27, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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 Oct 28, 2020
Trevor Hodges Individual Corporate DirectorCfo Jan 1, 2021
W-2 Managing EmployeeCfo Jan 1, 2021
Mark Rouleau Individual Corporate Officer Nov 24, 2021
Stephen Vairo Individual Corporate DirectorBoard Member Sep 1, 2013
Donald Simila Individual Corporate DirectorCeo Dec 1, 2010
W-2 Managing EmployeeCeo Dec 1, 2010
Kevin L Piggott Individual Corporate Officer Oct 31, 2018
Cathryn Beer Individual Corporate Officer Oct 26, 2016
Dianna Christenson Individual Corporate OfficerBoard Member Sep 1, 2013
Christopher Adams Individual Corporate Officer Jun 26, 2019
Julie Shaw Individual Corporate DirectorBoard Member Sep 1, 2013
Allen Mott Individual Corporate Officer Mar 28, 2018
Micah Stipech Individual Corporate Officer Mar 25, 2020

Practitioners & affiliated clinicians

Practitioners 9

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": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1104158690",
    "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": "906-346-9275",
            "fax_number": "906-372-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 EAST M 35",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498419159",
            "telephone_number": "906-346-9275",
            "fax_number": "906-372-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER GREAT LAKES FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gwinn Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gwinn Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gwinn, MI

Sources for this page

Verify at the official NPI Registry.