Great Lakes Spine and Medical PLLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GREAT LAKES SPINE AND MEDICAL PLLC

Practice address

4266 State St
Saginaw, MI 48603-4035

Phone

(989) 792-6702

Fax

(989) 792-1128

NPI assigned

Feb 16, 2023

Organization subpart

No

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

Authorized official

Name

Jeffrey A Kelly, DCNPI 1932159928

Title

Owner

Phone

(989) 792-6702

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Great Lakes Spine and Medical PLLC

  • Chiropractor
  • Saginaw, MI
  • NPI 1063111847

  O20230407000417

  Same enrollment
• Great Lakes Spine and Medical PLLC

  • General Practice Physician
  • Saginaw, MI
  • NPI 1699473033

  O20230407000417

  Same enrollment

Practitioners 8

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

• Jeffrey Alan Kelly, D.C.

  • Radiology Chiropractor
  • Saginaw, MI
  • NPI 1932159928
  NPD Authorized official
• Lorenzo D Berlanga, M.D.

  • Family Medicine Physician
  • Midland, MI
  • NPI 1063487411
  NPD
• Alexander Dalton, D.C.

  • Chiropractor
  • Saginaw, MI
  • NPI 1780033506
  NPD
• Kevin Jeremy Homer, DC

  • Chiropractor
  • Clarkston, MI
  • NPI 1801841846
  NPD
• Konnor Lyn Hunt, DC

  • Chiropractor
  • Hastings, MI
  • NPI 1851052716
  NPD
• Jorge Plasencia, M.D.

  • Family Medicine Physician
  • Saginaw, MI
  • NPI 1760466346
  NPD
• Christopher Stevenson, D.C.

  • Chiropractor
  • Saginaw, MI
  • NPI 1043050669
  NPD
• Richard Brian Szagesh, DC

  • Chiropractor
  • East Lansing, MI
  • NPI 1033179148
  NPD

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

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1336847730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4266 STATE ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486034035",
            "telephone_number": "989-792-6702",
            "fax_number": "989-792-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4266 STATE ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486034035",
            "telephone_number": "989-792-6702",
            "fax_number": "989-792-1128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SPINE AND MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-16",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-792-6702",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Family Health Center PC
• Great Lakes Health Foundation Inc.
• Great Lakes Home Care Partners LLC
• Great Lakes Home Health Care Agency, LLC
• Great Lakes Spine and Medical PLLC
• Great Lakes Spine and Medical PLLC
• Great Lakes Wellness Co.
• Adrian Green, MSW, LMSW
• Janice Campomanes Green
• Lorraine Renee Green, LBSW

• Durable Medical Equipment & Medical Supplies in Saginaw, MI
• Providers in Saginaw, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.