NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1528435526
Registry record updated Aug 25, 2022
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
700 Court St
Saginaw, MI 48602-4251
Phone
(989) 921-5372
NPI assigned
Aug 25, 2015
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

700 Court St
Saginaw, MI 48602-4251

Mailing address

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

Other names 1

  • Great Lakes Bay Health Centers Old Town Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151023000955 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 1528435526. Details of each certification follow.

Federally qualified health center certification: CCN 231077

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS OLD TOWN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2015
Last certification
Oct 22, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
700 Court St
Saginaw, MI 48602-4251

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

Locations

804 S Hamilton St
Saginaw, MI 48602
Phone (989) 343-0103

Ownership & related parties

All disclosed owners & managing parties 11

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 Aug 11, 2015
Suzanne Prich Individual Corporate DirectorBoard Member Aug 11, 2015
Albert Martenis Individual Corporate DirectorBoard Member Aug 11, 2015
Deborah Mack Individual Corporate DirectorBoard Member Aug 11, 2015
Kari J Gulvas Individual Corporate DirectorBoard Member Aug 11, 2015
Brenda M Coughlin Individual Corporate DirectorBoard Member Aug 11, 2015
W-2 Managing EmployeeCeo Aug 11, 2015 100%
Lisa Keyser Individual Corporate DirectorBoard Member Aug 11, 2015
Timothy Zlomak Individual Corporate DirectorBoard Member Aug 11, 2015
Tarshia Lewis Individual Corporate DirectorBoard Member Aug 11, 2015
Lisa Galonska Individual Corporate DirectorBoard Member Aug 11, 2015
Sam Pruitt Individual Corporate DirectorBoard Member Aug 11, 2015

Owners & managing parties with NPI records 1

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": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1528435526",
    "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": "989-399-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 COURT ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024251",
            "telephone_number": "989-921-5372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "GALONSKA",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers Old Town",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Great Lakes Bay Health Centers Old Town",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.