Great Lakes Bay Health Centers

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

GREAT LAKES BAY HEALTH CENTERS

Practice address

501 Lapeer Ave
Saginaw, MI 48607-1208

Phone

(989) 759-6464

Fax

(989) 399-8233

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI9 enrollments

Enrollment records 9

Federally qualified health center certification: CCN 231890

Legal name

GREAT LAKES BAY HEALTH CENTERS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 5, 2004

Last certification

Feb 5, 2004

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 1968 in MI

Enrollment address

3175 Professional CT
Bay City, MI 48706-2823

Federally qualified health center certification: CCN 231902

Legal name

GREAT LAKES BAY HEALTH CENTERS

Doing business as

GREAT LAKES BAY HEALTH CENTERS DAVID R GAMEZ

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 3, 2004

Last certification

Nov 3, 2004

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 1968 in MI

Enrollment address

501 Lapeer Ave
Saginaw, MI 48607-1203

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

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

Federally qualified health center certification: CCN 231882

Legal name

GREAT LAKES BAY HEALTH CENTERS

Doing business as

GREAT LAKES BAY HEALTH CENTERS BRIDGEPORT

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 1, 2001

Last certification

Sep 1, 2001

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 1968 in MI

Enrollment address

6297 Dixie Hwy
Bridgeport, MI 48722-9635

Federally qualified health center certification: CCN 231884

Legal name

GREAT LAKES BAY HEALTH CENTERS

Doing business as

GREAT LAKES BAY HEALTH CENTERS WOLVERINE VASSAR

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 3, 2002

Last certification

Oct 3, 2002

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 1968 in MI

Enrollment address

1015 Commerce Dr
Vassar, MI 48768-9589

Federally qualified health center certification: CCN 231810

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

3884 Monitor Rd
Bay City, MI 48706-9298

Federally qualified health center certification: CCN 231883

Legal name

GREAT LAKES BAY HEALTH CENTERS

Doing business as

GREAT LAKES BAY HEALTH CENTERS WOLVERINE SAGINAW

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 3, 2002

Last certification

Oct 3, 2002

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 1968 in MI

Enrollment address

2424 N Outer Dr
Saginaw, MI 48601-6010

Related certifications (CCN) 2

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

• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1427176502

  Related provider number

  Provider of Services
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1972621753

  Related provider number

  Provider of Services

Other NPIs on the same Medicare enrollment 10

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

• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, MI
  • NPI 1215055306

  O20061212000671

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1336267111

  O20070202000514

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1427176502

  O20050216001010

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1629171707

  O20040126000171

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Vassar, MI
  • NPI 1740308832

  O20061212000680

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1780702571

  O20061212000669

  Same enrollment
• Great Lakes Bay Health Centers

  • Obstetrics & Gynecology Physician
  • Saginaw, MI
  • NPI 1871684761

  O20040126000171

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bay City, MI
  • NPI 1881712669

  O20031229000343

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
  • NPI 1972621753

  O20041007000550

  Same enrollment
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bay City, MI
  • NPI 1982722039

  O20061214000022

  Same enrollment

All disclosed owners & managing parties 22

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

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Brenda Marie Coughlin, MD

  • Family Medicine Physician
  • Saginaw, MI
  • NPI 1609864495

  Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership
• Tracey Sue Dore

  • Clinical Social Worker
  • Bad Axe, MI
  • NPI 1225277569

  Corporate Director

  CMS ownership
• John Arthur Martin, PA

  • Physician Assistant
  • Bay City, MI
  • NPI 1386632164

  Corporate Director

  CMS ownership
• Kellie J Treichel Pergande, D.C.

  • Chiropractor
  • Bay City, MI
  • NPI 1295741023

  Corporate Director

  CMS ownership

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Curtis Crowley, D.M.D.

  • General Practice Dentistry
  • Flint, MI
  • NPI 1760580948
  NPD (past)
• Quinn Curry

  • Dental Hygienist
  • Saginaw, MI
  • NPI 1669859658
  NPD (past)
• Robert Crawford Dennison, DMD

  • Dentist
  • Saginaw, MI
  • NPI 1497743710
  NPD (past)
• Shana Dorland, DDS

  • Dentist
  • Saginaw, MI
  • NPI 1861871436
  NPD (past)
• Velma Hall

  • Dental Hygienist
  • Saginaw, MI
  • NPI 1982081451
  NPD (past)
• Marisa Marie Hart, DDS

  • Dentist
  • Lansing, MI
  • NPI 1457467839
  NPD (past)
• Edward Emad Hassan, DDS.

  • Dentist
  • Midland, MI
  • NPI 1093978306
  NPD (past)
• Tsao-Yin Liu, DDS

  • Dentist
  • Midland, MI
  • NPI 1750586756
  NPD (past)
• Joao Najar, DDS

  • Dentist
  • Commerce, MI
  • NPI 1386991008
  NPD (past)
• Jennilee O'Neil

  • Dental Hygienist
  • Saginaw, MI
  • NPI 1386021855
  NPD (past)
• Chelsea Pinozek, DDS

  • Dentist
  • Saginaw, MI
  • NPI 1326495961
  NPD (past)
• Melody Steckert

  • Dental Hygienist
  • Saginaw, MI
  • NPI 1689051161
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1801907654",
    "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": "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": "501 LAPEER AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486071208",
            "telephone_number": "989-759-6464",
            "fax_number": "989-399-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-09-19",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0G36111 MEEDICARE PAY BILL TO",
            "identifier": "0G36111",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers
• Great Lakes Bay Health Centers

• All providers in Saginaw, MI
• Federally Qualified Health Center (FQHC) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.