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Baldwin Family Health Care

Organization Active NPI Optometrist · Baldwin, MI

NPI 1902308463 · NPPES record last updated May 30, 2023

Key facts

NPI
1902308463
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
BALDWIN FAMILY HEALTH CARE
Practice address
1101 Washington St
Baldwin, MI 49304
Phone
(231) 745-4624
Fax
(231) 745-5031
NPI assigned
Mar 1, 2018
Organization subpart
Yes
Parent organization (as reported)
BALDWIN FAMILY HEALTH CARE

Authorized official

Name
Julie Tatko
Title
Administrative Assistant
Phone
(231) 745-2743

Other NPIs on the same Medicare enrollment 17

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

Other NPIs with the same Medicare PAC ID 18

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 22

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 35

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

View all 35

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

Federally qualified health center certification: CCN 231133

Legal name
BALDWIN FAMILY HEALTH CARE
Doing business as
BALDWIN FAMILY HEALTH CARE VISION CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 15, 2018
Last certification
May 15, 2018
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Apr 5, 1974 in MI
Enrollment address
1101 Washington St
Baldwin, MI 49304-8199

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Pamela Panetta
Individual 		Corporate Director
Secretary		 Oct 1, 2018
Ashley Hawkins
Individual 		Corporate Director
Board Member		 Jan 23, 2023
Susan Olds
Individual 		Corporate Director
Board Member		 Jul 25, 2019
Mary Martin
Individual 		Corporate Director
Board Member		 Jul 25, 2022
Corey Vanfleet
Individual 		Corporate Director
Board Member		 May 1, 1996
Robert Fisher
Individual 		Corporate Director
Chairman		 Apr 1, 1992
Eric Davidson
Individual 		Corporate Director
Vice Chairman		 May 1, 1996
Julie Tatko
Individual 		Corporate Director
Ceo		 Sep 1, 2020
W-2 Managing Employee
Ceo		 Sep 1, 2020
Mason Husby
Individual 		Corporate Officer
Vice President and Cfo		 Apr 1, 2018
Marissa Kelly
Individual 		Corporate Director
Board Member		 Dec 1, 2021
Bruce Whitney
Individual 		Corporate Director
Treasurer		 Jan 23, 2014

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040209001155 MI Part B Supplier - Clinic/Group Practice 1153215413 Receives reassigned benefits from 50 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grant, MI; Kent City, MI; Leroy, MI; McBain, MI; Newaygo, MI; Reed City, MI; White Cloud, MI; Cadillac, MI…
O20180517002242 MI Part a Provider - Federally Qualified Health Center (FQHC) 1153215413 Practice locations: Baldwin, MI

National Provider Directory

Tax ID family
Rowland Family Health C (23 organizations share this tax ID)
Part of
Rowland Family Health C

Locations

1101 Washington St
Baldwin, MI 49304
Phone (231) 745-2020

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

1101 Washington St
Baldwin, MI 49304

Mailing address

1615 Michigan Ave
Baldwin, MI 49304-7984
Phone (231) 745-2743

Other identifiers

IdentifierTypeStateIssuer
0D36000OtherMIBSBSM

Other names

  • Baldwin Family Heatlh Care Vision Center Doing business as

Other providers in Baldwin, MI

All providers in Baldwin, MI · Optometrist in Michigan

Sources for this page

Verify at the official NPI Registry.