NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1780702571
Registry record updated Feb 8, 2023
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
1522 Janes Ave
Saginaw, MI 48601-1819
Phone
(989) 755-0316
Fax
(989) 755-0956
NPI assigned
Mar 27, 2007
Last updated
Feb 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Authorized official

Name
Lisa M Galonska
Title
Vice President
Phone
(989) 759-6448

Specialties & licenses 1

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

Addresses

Primary practice location

1522 Janes Ave
Saginaw, MI 48601-1819

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 Janes Street Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061212000669 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 1780702571. Details of each certification follow.

Federally qualified health center certification: CCN 231811

Legal name
GREAT LAKES BAY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 1992
Last certification
Apr 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
1522 Janes Ave
Saginaw, MI 48601-1819

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 14

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 Director Jan 13, 2017
Suzanne Prich Individual Corporate Director Jan 13, 2017
Albert Martenis Individual Corporate Director Jan 13, 2017
Deborah Mack Individual Corporate Director Jan 13, 2017
Brenda M Coughlin Individual Corporate Director Jan 13, 2017
Timothy Zlomak Individual Corporate Director Jan 13, 2017
Jesus Hernandez Individual Corporate Director Jan 13, 2017
Tarshia Lewis Individual Corporate Director Jan 13, 2017
Dawn Christian Individual W-2 Managing Employee Jan 13, 2017
Earl J Sams Individual Corporate Director Jun 1, 2002
Lisa Galonska Individual Corporate OfficerInterium President Dec 1, 2011
Carni Applegate Individual Corporate Director Jan 13, 2017
Kellie Jo Treichel-Pergande Individual Corporate Director Jan 13, 2017
Sam Pruitt Individual Corporate Director Jan 13, 2017

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": "1675814400000",
    "number": "1780702571",
    "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": "1522 JANES AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486011819",
            "telephone_number": "989-755-0316",
            "fax_number": "989-755-0956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "GALONSKA",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "989-759-6448"
    },
    "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 Janes Street",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Great Lakes Bay Health Centers Janes Street",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.