NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bay City, MI
National Provider Identifier
1881712669
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
3175 W Professional Drive
Bay City, MI 48706-2823
Phone
(989) 667-3377
Fax
(989) 667-9991
NPI assigned
Mar 27, 2007
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 MI Primary

Addresses

Primary practice location

3175 W Professional Drive
Bay City, MI 48706-2823

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 Women's Care Bay City Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000343 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
Practice locations: Bay City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881712669. 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

Other NPIs on the same Medicare enrollment 1

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

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
23D0374996Great Lakes Bay Health Centers3175 West Professional Drive, Bay City, MI 48706Provider-performed microscopyAug 31, 2026

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 22

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

View all 22

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
Craig Tatum Individual Corporate Director Feb 16, 2023
Suzanne Prich Individual Corporate Director May 1, 2014
Albert Martenis Individual Corporate DirectorVice Chair Oct 1, 2013
Deborah Mack Individual Corporate DirectorTreasurer Oct 1, 2014
Tracey S Dore Individual Corporate Director Feb 16, 2023
Brenda M Coughlin Individual W-2 Managing Employee Dec 21, 2016
Timothy Zlomak Individual Corporate DirectorBoard Chair May 1, 2012
Monica Reyes Individual Corporate Director Feb 16, 2023
Dawn Christian Individual Corporate Officer Dec 21, 2016
Saleem a Mannan Individual Corporate Director Feb 16, 2023
Lisa Galonska Individual Corporate Officer Dec 21, 2016
John a Martin Individual Corporate Director Feb 16, 2023
Sam Pruitt Individual Corporate DirectorSecretary Nov 1, 2013
Dwayne Parker Individual Corporate Director Feb 16, 2023

Owners & managing parties with NPI records 3

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": "1474243200000",
    "number": "1881712669",
    "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": "3175 W PROFESSIONAL DRIVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487062823",
            "telephone_number": "989-667-3377",
            "fax_number": "989-667-9991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BAY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "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": "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 Women's Care Bay City",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bay City, MI

Sources for this page

Verify at the official NPI Registry.