NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bay City, MI
National Provider Identifier
1447804604
Registry record updated Jul 26, 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
690 S Trumbull St
Bay City, MI 48708-7692
Phone
(989) 922-4900
NPI assigned
Jul 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 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

690 S Trumbull St
Bay City, MI 48708-7692

Mailing address

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

Other names 1

  • Great Lakes Bay Health Centers Bay City South Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191206000504 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 Practice locations: Bay City, MI

Federally qualified health center certification: CCN 231149

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS BAY CITY SOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 3, 2019
Last certification
Dec 3, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
690 S Trumbull St
Bay City, MI 48708-7692

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2170492Great Lakes Bay Health Centers Bay City South690 S Trumbull St, Bay City, MI 48708Provider-performed microscopyAug 12, 2027

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 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 Apr 17, 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 Apr 17, 2025
Monica Reyes Individual Corporate DirectorBoard Member Oct 1, 2019
Josie King Individual Corporate DirectorBoard Member Apr 17, 2025
Tarshia Lewis Individual Corporate DirectorBoard Member Oct 1, 2019
Jacob Cristoforo Individual Corporate DirectorBoard Member Apr 17, 2025
Dawn Christian Individual Corporate Officer Oct 1, 2019
Saleem a Mannan Individual Corporate DirectorBoard Member Apr 17, 2025
Michelle Stolsmark Individual Corporate DirectorBoard Member Apr 17, 2025
Lisa Galonska Individual Corporate Officer Oct 1, 2019
John Rezayi Individual Corporate DirectorBoard Member Apr 17, 2025
John a Martin Individual Corporate DirectorBoard Member Apr 17, 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": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1447804604",
    "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": "690 S TRUMBULL ST",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487087692",
            "telephone_number": "989-922-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "last_updated": "2019-07-26",
        "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 Bay City South",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bay City, MI

Sources for this page

Verify at the official NPI Registry.