NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1386290153
Registry record updated Aug 16, 2019
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
Practice address
3021 Court St
Saginaw, MI 48602-3620
Phone
(989) 399-5600
NPI assigned
Aug 16, 2019
Last updated
Aug 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Authorized official

Name
Dawn Christian
Title
Provider Enrollment
Phone
(989) 759-6464

Specialties & licenses 1

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

Addresses

Primary practice location

3021 Court St
Saginaw, MI 48602-3620

Mailing address

501 Lapeer Ave
Saginaw, MI 48607-1203
Phone (989) 759-6464

Other names 1

  • Great Lakes Bay Health Centers Thompson Middle School Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191028000585 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 Practice locations: Saginaw, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386290153. Details of each certification follow.

Federally qualified health center certification: CCN 231151

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS THOMPSON MIDDLE SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 28, 2019
Last certification
Oct 28, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3021 Court St
Saginaw, MI 48602-3620

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 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Craig Tatum Individual Corporate DirectorBoard Member Jun 11, 2025
Albert Martenis Individual Corporate DirectorBoard Member Oct 1, 2019
Deborah Mack Individual Corporate DirectorBoard Member Oct 1, 2019
Brenda M Coughlin Individual W-2 Managing EmployeeCeo Oct 1, 2019 100%
Timothy Zlomak Individual Corporate DirectorBoard Member Oct 1, 2019
Lisa Wilson Individual Corporate DirectorBoard Member Jun 11, 2025
Monica Reyes Individual Corporate DirectorBoard Member Oct 1, 2019
Josie King Individual Corporate DirectorBoard Member Jun 11, 2025
Tarshia Lewis Individual Corporate DirectorBoard Member Oct 1, 2019
Jacob Cristoforo Individual Corporate DirectorBoard Member Jun 11, 2025
Dawn Christian Individual Corporate Officer Oct 1, 2019
Saleem a Mannan Individual Corporate DirectorBoard Member Jun 11, 2025
Michelle Stolsmark Individual Corporate DirectorBoard Member Jun 11, 2025
Lisa Galonska Individual Corporate Officer Oct 1, 2019
John Rezayi Individual Corporate DirectorBoard Member Jun 11, 2025
John a Martin Individual Corporate DirectorBoard Member Jun 11, 2025
Sam Pruitt Individual Corporate DirectorBoard Member Oct 1, 2019
Dwayne Parker Individual Corporate DirectorBoard Member Oct 1, 2019

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565913600000",
    "number": "1386290153",
    "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": "486071203",
            "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": "3021 COURT ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486023620",
            "telephone_number": "989-399-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-16",
        "last_updated": "2019-08-16",
        "status": "A",
        "authorized_official_last_name": "CHRISTIAN",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "989-759-6464"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers Thompson Middle School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.