NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1801907654
Registry record updated Sep 19, 2016
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
501 Lapeer Ave
Saginaw, MI 48607-1208
Phone
(989) 759-6464
Fax
(989) 399-8233
NPI assigned
Aug 31, 2006
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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 Primary

Addresses

Primary practice location

501 Lapeer Ave
Saginaw, MI 48607-1208

Mailing address

501 Lapeer Ave
Saginaw, MI 48607-1208
Phone (989) 759-6464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20031229000343 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bay City, MI
O20040126000171 MI Part B Supplier - Clinic/Group Practice 2466369046 Receives reassigned benefits from 238 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Branch, MI; Vassar, MI; Bay City, MI; Saginaw, MI; Bad Axe, MI; Belding, MI; Owosso, MI; Bridgeport, MI
O20041007000550 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saginaw, MI
O20050216001010 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saginaw, MI
O20061212000669 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saginaw, MI
O20061212000671 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bridgeport, MI
O20061212000680 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vassar, MI
O20061214000022 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bay City, MI
O20070202000514 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saginaw, MI

NPI to CCN mapping 8

The Medicare certification numbers (CCNs) connected to NPI 1801907654. Details of each certification follow.

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

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

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

Locations

2308 Wadsworth Ave
Saginaw, MI 48601
Phone (989) 754-7771

Ownership & related parties

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.

NameRoleSinceShare
Craig Tatum Individual Corporate Director Feb 16, 2023
Suzanne Prich Individual Corporate Director May 1, 2014
Corporate DirectorBoard Member May 1, 2014
Corporate Director Jan 13, 2017
Corporate Director Jan 4, 2017
Albert Martenis Individual Corporate DirectorVice Chair Oct 1, 2013
Corporate Director Oct 1, 2013
Corporate DirectorBoard Member Oct 1, 2013
Corporate Director Jan 13, 2017
Corporate Director Jan 4, 2017
Corporate DirectorVice Chair Jan 4, 2017
Deborah Mack Individual Corporate DirectorTreasurer Oct 1, 2014
Corporate Director Oct 1, 2014
Corporate DirectorBoard Member Oct 1, 2014
Corporate Director Jan 13, 2017
Corporate DirectorTreasurer Jan 4, 2017
Tracey S Dore Individual Corporate Director Feb 16, 2023
Brenda M Coughlin Individual W-2 Managing Employee Dec 21, 2016
Corporate OfficerPresident / Ceo Nov 3, 2016 100%
W-2 Managing EmployeePresident & Ceo Nov 3, 2016
Corporate Director Jan 13, 2017
W-2 Managing EmployeeCeo Jan 4, 2017
Corporate OfficerPresident / Ceo Nov 3, 2016
W-2 Managing Employee Jan 13, 2017
Corporate DirectorBoard President Feb 16, 2023
W-2 Managing Employee Jan 4, 2017
Timothy Zlomak Individual Corporate DirectorBoard Chair May 1, 2012
Corporate Director May 1, 2012
Corporate Director Jan 24, 2017
Corporate Director Jan 13, 2017
Corporate DirectorChairman Jan 4, 2017
Corporate DirectorBoard Member May 1, 2012
Corporate DirectorBoard Chair Jan 4, 2017
Monica Reyes Individual Corporate Director Feb 16, 2023
Dawn Christian Individual Corporate Officer Dec 21, 2016
W-2 Managing EmployeeProvider Enrollment Coordinator Dec 21, 2016
W-2 Managing EmployeeProvider Enrollment Coordinator Jan 24, 2017
W-2 Managing Employee Jan 13, 2017
Corporate OfficerProvider Enrollment Coordinator Jan 4, 2017
Corporate OfficerProvider Enrollment Jan 13, 2017
Saleem a Mannan Individual Corporate Director Feb 16, 2023
Lisa Galonska Individual Corporate Officer Dec 21, 2016
Corporate OfficerVice President Dec 1, 2011
Corporate OfficerInterium President Dec 1, 2011
John a Martin Individual Corporate Director Feb 16, 2023
Sam Pruitt Individual Corporate DirectorSecretary Nov 1, 2013
Corporate Director Nov 1, 2013
Corporate DirectorBoard Member Nov 1, 2013
Corporate Director Jan 13, 2017
Corporate DirectorSecretary Jan 4, 2017
Dwayne Parker Individual Corporate Director Feb 16, 2023
Michael Durussel Individual Corporate Director Jan 2, 2012
Corporate DirectorBoard Member Jan 1, 2012
Corporate Director Jan 13, 2017
Jesus Hernandez Individual Corporate Director Jan 2, 2016
Corporate DirectorBoard Member Jan 2, 2015
Corporate Director Jan 13, 2017
Corporate Director Jan 4, 2017
Tarshia Lewis Individual Corporate Director Oct 1, 2014
Corporate DirectorBoard Member Oct 1, 2014
Corporate Director Jan 13, 2017
Carni Applegate Individual Corporate Director Jan 2, 2016
Corporate DirectorBoard Member Jan 2, 2016
Corporate Director Jan 13, 2017
Kellie Jo Treichel-Pergande Individual Corporate Director Jul 1, 2016
Corporate DirectorBoard Member Jul 1, 2016
Corporate Director Jan 13, 2017
Earl J Sams Individual Corporate Director Jun 1, 2002
Josie King Individual Corporate Director Feb 16, 2023
Michelle Stolsmark Individual Corporate Director Feb 16, 2023

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.