NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1427176502
Registry record updated Apr 3, 2024
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
3400 S Washington Rd
Saginaw, MI 48601-4958
Phone
(989) 759-6464
Fax
(989) 399-8233
NPI assigned
Mar 27, 2007
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Lisa Galonaska
Title
Vice President
Phone
(989) 759-6464

Specialties & licenses 1

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

Addresses

Primary practice location

3400 S Washington Rd
Saginaw, MI 48601-4958

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0G36111OtherMI0G36111 MEDICARE BILL PAY TO

Other names 1

  • Great Lakes Bay Health Centers St. Vincent Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050216001010 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
Practice locations: Saginaw, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427176502. Details of each certification follow.

Federally qualified health center certification: CCN 231904

Legal name
GREAT LAKES BAY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 2, 2005
Last certification
May 2, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
3400 S Washington Rd
Saginaw, MI 48601-4958
Related CCNs
231902

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Bay Health Centers67 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 13

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

NameRoleSinceShare
Michael Durussel Individual Corporate DirectorBoard Member Jan 1, 2012
Suzanne Prich Individual Corporate DirectorBoard Member May 1, 2014
Albert Martenis Individual Corporate DirectorBoard Member Oct 1, 2013
Deborah Mack Individual Corporate DirectorBoard Member Oct 1, 2014
Brenda M Coughlin Individual Corporate OfficerPresident / Ceo Nov 3, 2016 100%
W-2 Managing EmployeePresident & Ceo Nov 3, 2016
Timothy Zlomak Individual Corporate Director Jan 24, 2017
Jesus Hernandez Individual Corporate DirectorBoard Member Jan 2, 2015
Tarshia Lewis Individual Corporate DirectorBoard Member Oct 1, 2014
Dawn Christian Individual W-2 Managing EmployeeProvider Enrollment Coordinator Jan 24, 2017
Lisa Galonska Individual Corporate OfficerVice President Dec 1, 2011
Carni Applegate Individual Corporate DirectorBoard Member Jan 2, 2016
Kellie Jo Treichel-Pergande Individual Corporate DirectorBoard Member Jul 1, 2016
Sam Pruitt Individual Corporate DirectorBoard Member Nov 1, 2013

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1427176502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAPEER",
            "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": "3400 S WASHINGTON RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486014958",
            "telephone_number": "989-759-6464",
            "fax_number": "989-399-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "GALONASKA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "989-759-6464"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0G36111  MEDICARE BILL PAY TO",
            "identifier": "0G36111",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers St. Vincent",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.