NPIMap

Organization Active NPI

Baldwin Family Health Care

Doing business as Baldwin Family Heatlh Care Vision Center

  • Optometrist
  • Baldwin, MI
National Provider Identifier
1902308463
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BALDWIN FAMILY HEALTH CARE
Doing business as
Baldwin Family Heatlh Care Vision Center
Practice address
1101 Washington St
Baldwin, MI 49304
Phone
(231) 745-4624
Fax
(231) 745-5031
NPI assigned
Mar 1, 2018
Last updated
May 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BALDWIN FAMILY HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Optometrist 152W00000X Primary

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 1

IdentifierTypeStateIssuer
0D36000OtherMIBSBSM

Other names 1

  • Baldwin Family Heatlh Care Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902308463. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 5, 1974 in MI
Enrollment address
1101 Washington St
Baldwin, MI 49304-8199

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Rowland Family Health C23 organizations share this tax ID, including this one
Part of
Rowland Family Health C

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

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 DirectorSecretary Oct 1, 2018
Ashley Hawkins Individual Corporate DirectorBoard Member Jan 23, 2023
Susan Olds Individual Corporate DirectorBoard Member Jul 25, 2019
Mary Martin Individual Corporate DirectorBoard Member Jul 25, 2022
Corey Vanfleet Individual Corporate DirectorBoard Member May 1, 1996
Robert Fisher Individual Corporate DirectorChairman Apr 1, 1992
Eric Davidson Individual Corporate DirectorVice Chairman May 1, 1996
Julie Tatko Individual Corporate DirectorCeo Sep 1, 2020
W-2 Managing EmployeeCeo Sep 1, 2020
Mason Husby Individual Corporate OfficerVice President and Cfo Apr 1, 2018
Marissa Kelly Individual Corporate DirectorBoard Member Dec 1, 2021
Bruce Whitney Individual Corporate DirectorTreasurer Jan 23, 2014

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": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1902308463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 MICHIGAN AVE",
            "city": "BALDWIN",
            "state": "MI",
            "postal_code": "493047984",
            "telephone_number": "231-745-2743",
            "fax_number": "231-745-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 WASHINGTON ST",
            "city": "BALDWIN",
            "state": "MI",
            "postal_code": "49304",
            "telephone_number": "231-745-4624",
            "fax_number": "231-745-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALDWIN FAMILY HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BALDWIN FAMILY HEALTH CARE",
        "enumeration_date": "2018-03-01",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "TATKO",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "231-745-2743"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSBSM",
            "identifier": "0D36000",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baldwin Family Heatlh Care Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baldwin Family Heatlh Care Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baldwin, MI

Sources for this page

Verify at the official NPI Registry.