NPIMap

Organization Active NPI

Upper Great Lakes Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Calumet, MI
National Provider Identifier
1114354479
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
Practice address
56720 Calumet Ave
Calumet, MI 49913-1967
Phone
(906) 483-1177
Fax
(906) 372-3230
NPI assigned
Oct 2, 2013
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
Trevor Hodges
Title
Ceo
Phone
(906) 483-1846

Specialties & licenses 1

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

Addresses

Primary practice location

56720 Calumet Ave
Calumet, MI 49913-1967

Mailing address

135 E M35
Gwinn, MI 49841-9160
Phone (906) 483-1177

Other names 1

  • Calumet Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140218001801 MI Part A Provider - Federally Qualified Health Center (FQHC) 1951432384 Practice locations: Calumet, MI

Federally qualified health center certification: CCN 231017

Legal name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Doing business as
CALUMET FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 21, 2014
Last certification
Mar 21, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2013 in MI
Enrollment address
56720 Calumet Ave
Calumet, MI 49913-1967

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Upper Great Lakes Center18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

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, 2020
W-2 Managing EmployeeCfo Jan 1, 2020
Mark Rouleau Individual Corporate Officer Nov 24, 2021
Stephen Vairo Individual Corporate Officer Oct 7, 2009
Donald Simila Individual Corporate OfficerCeo Jan 1, 2014 100%
W-2 Managing Employee Jan 1, 2014 100%
Kevin L Piggott Individual Corporate Officer Oct 31, 2018
Cathryn Beer Individual Corporate Officer Oct 26, 2016
Dianna Christenson Individual Corporate Officer Dec 4, 2013
Christopher Adams Individual Corporate Officer Jun 26, 2019
Julie Shaw Individual Corporate Officer Sep 25, 2019
Allen Mott Individual Corporate Officer Mar 28, 2018
Micah Stipech Individual Corporate Officer Mar 25, 2020

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1114354479",
    "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": "906-483-1177",
            "fax_number": "906-372-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56720 CALUMET AVE",
            "city": "CALUMET",
            "state": "MI",
            "postal_code": "499131967",
            "telephone_number": "906-483-1177",
            "fax_number": "906-372-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER GREAT LAKES FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "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": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calumet Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Calumet Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Calumet, MI

Sources for this page

Verify at the official NPI Registry.