NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1871611665
Registry record updated Jan 19, 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
229 Gallagher
Saginaw, MI 48601-3252
Phone
(989) 755-3619
Fax
(989) 755-3624
NPI assigned
Mar 27, 2007
Last updated
Jan 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 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 MI Primary

Addresses

Primary practice location

229 Gallagher
Saginaw, MI 48601-3252

Mailing address

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

Other names 1

  • Great Lakes Bay Health Centers Roosevelt S Ruffin Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120127000374 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 1871611665. Details of each certification follow.

Federally qualified health center certification: CCN 231980

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS ROOSEVELT S RUFFIN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2012
Last certification
Apr 4, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
229 Gallagher St
Saginaw, MI 48601-3252

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0926433Great Lakes Bay Health Centers229 Gallagher, Saginaw, MI 48601Provider-performed microscopyMar 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Bay Health Center67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

229 Gallagher St
Saginaw, MI 48601
Phone (989) 249-0024

Ownership & related parties

All disclosed owners & managing parties 13

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 Jan 1, 2012
Suzanne Prich Individual Corporate DirectorBoard Member May 1, 2014
Albert Martenis Individual Corporate DirectorBoard Member Oct 1, 2013
Deborah Mack Individual Corporate DirectorBoard Member Oct 1, 2014
Brenda M Coughlin Individual W-2 Managing EmployeePresident / Ceo Nov 3, 2016
Timothy Zlomak Individual Corporate DirectorBoard Member May 1, 2012
Jesus Hernandez Individual Corporate DirectorBoard Member Jan 2, 2015
Tarshia Lewis Individual Corporate DirectorBoard Member Oct 1, 2014
Dawn Christian Individual Corporate Officer Nov 3, 2016
Lisa Galonska Individual Corporate OfficerVice President Dec 1, 2011
Carni Applegate Individual Corporate DirectorBoard Member Jan 2, 2016
Kellie Jo Treichel-Pergande Individual Corporate DirectorBoard Member Jul 1, 2016
Sam Pruitt Individual Corporate DirectorBoard Member Nov 1, 2013

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1871611665",
    "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": "229 GALLAGHER",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486013252",
            "telephone_number": "989-755-3619",
            "fax_number": "989-755-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "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": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers Roosevelt S Ruffin",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Great Lakes Bay Health Centers Roosevelt S Ruffin",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.