NPIMap

Organization Active NPI

Upper Great Lakes Family Health Center

Doing business as UGL MSU Tele-Psychiatry

  • Psychiatry Physician
  • East Lansing, MI
National Provider Identifier
1659889673
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Doing business as
UGL MSU Tele-Psychiatry
Practice address
965 Fee Rd RM A229
East Lansing, MI 48824-6410
Phone
(906) 483-1177
Fax
(906) 481-3094
NPI assigned
Jan 11, 2018
Last updated
Jun 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Authorized official

Name
Rebecca Gaffney
Title
Business Office Director
Phone
(906) 481-8585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

965 Fee Rd RM A229
East Lansing, MI 48824-6410

Mailing address

301 Explorer St
Gwinn, MI 49841-2813
Phone (906) 481-8586

Other names 1

  • UGL MSU Tele-Psychiatry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100629000853 MI Part B Supplier - Clinic/Group Practice 1951432384 Receives reassigned benefits from 63 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Menominee, MI; Marquette, MI; Gwinn, MI; Iron River, MI; East Lansing, MI; Calumet, MI; Hancock, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659889673. Details of each certification follow.

  • CCN 231136 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231136

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
UGL MSU TELE-PSYCHIATRY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 17, 2018
Last certification
Jul 17, 2018
Ownership / control type
For profit – corporation
Facility address
965 Fee Rd, RM A229
East Lansing, MI 48824

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1659889673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 EXPLORER ST",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498412813",
            "telephone_number": "906-481-8586",
            "fax_number": "906-483-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 FEE RD RM A229",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488246410",
            "telephone_number": "906-483-1177",
            "fax_number": "906-481-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER GREAT LAKES FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-11",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "GAFFNEY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "906-481-8585"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UGL MSU Tele-Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.