NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

Doing business as Great Lakes Bay Health Centers Shiawassee

  • Federally Qualified Health Center (FQHC)
  • Owosso, MI
National Provider Identifier
1184054892
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
Great Lakes Bay Health Centers Shiawassee
Practice address
200 N Caledonia Dr
Owosso, MI 48867
Phone
(989) 729-4848
Fax
(989) 729-4849
NPI assigned
Nov 15, 2013
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Lisa Galonska
Title
Interum President
Phone
(989) 759-6464

Specialties & licenses 1

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

Addresses

Primary practice location

200 N Caledonia Dr
Owosso, MI 48867

Mailing address

501 Lapeer Ave
Saginaw, MI 48607-1208
Phone (989) 759-6464

Other names 1

  • Great Lakes Bay Health Centers Shiawassee Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131211001782 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 Practice locations: Owosso, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184054892. Details of each certification follow.

Federally qualified health center certification: CCN 231013

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS SHIAWASSEE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 22, 2014
Last certification
Jan 22, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
200 N Caledonia Dr
Owosso, MI 48867-8844

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Bay Health Center67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

200 N Caledonia Dr
Owosso, MI 48867
Phone (989) 720-4188

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Suzanne Prich Individual Corporate Director Feb 8, 2022
Albert Martenis Individual Corporate Director Feb 8, 2022
Deborah Mack Individual Corporate Director Feb 8, 2022
Brenda M Coughlin Individual W-2 Managing EmployeeCeo Nov 1, 2013 100%
Timothy Zlomak Individual Corporate Director Feb 8, 2022
Jesus Hernandez Individual Corporate Director Feb 8, 2022
Monica Reyes Individual Corporate Director Feb 8, 2022
Josie King Individual Corporate Director Feb 8, 2022
Saleem a Mannan Individual Corporate DirectorBoard Member Nov 1, 2013
Michelle Stolsmark Individual Corporate Director Feb 8, 2022
Lisa Galonska Individual Corporate OfficerInterim President / Vice Preside Nov 1, 2013
John a Martin Individual Corporate Director Feb 8, 2022
Sam Pruitt Individual Corporate Director Feb 8, 2022
Dwayne Parker Individual Corporate Director Feb 8, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1184054892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAPEER AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486071208",
            "telephone_number": "989-759-6464",
            "fax_number": "989-399-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N CALEDONIA DR",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "48867",
            "telephone_number": "989-729-4848",
            "fax_number": "989-729-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "GALONSKA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "INTERUM PRESIDENT",
        "authorized_official_telephone_number": "989-759-6464"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers Shiawassee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owosso, MI

Sources for this page

Verify at the official NPI Registry.