Baldwin Family Health Care
Organization Active NPI Federally Qualified Health Center (FQHC) · Evart, MI
NPI 1912774282 · NPPES record last updated Mar 26, 2024
Key facts
- NPI
- 1912774282
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BALDWIN FAMILY HEALTH CARE
- Practice address
- 321 N Hemlock St
Evart, MI 49631-9588 - Phone
- (231) 734-4219
- Fax
- (231) 734-9974
- NPI assigned
- Dec 7, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- BALDWIN FAMILY HEALTH CARE
Authorized official
- Name
- Julie Tatko
- Title
- Ceo
- Phone
- (231) 745-2743
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 18
Practitioners 36
-
Shawn Andrus, OD
-
Amanda Jean Barton, FNP
-
Jonathon Eugene Borton, PA-C
-
Daniel James Bow, D.O.
-
Brian Patrick Dykes, L.P.C.
-
Rebecca M Ganzow-Fortier, PA-C
-
Jeremy Garrett, NP
-
Dannie Joe Gentry Jr., M.D.
-
Kristina Marie Hug, FNP-C
-
Mary Theresa Leone, M.A.
-
Samantha N Lopez, FNP
-
Kimberly Ann McCane, L.M.S.W
-
Russell McDaniel, PA-C
-
Roberto Miller, PA-C
-
Pamela B Mir, MD
-
Michael Joseph Morgan, PHD NP
-
Dawn Lynnette Paris, LMSW
-
Becky Lynn Porter, FNP-C
-
Amanda Reed, NP
-
Felisha Robinson, LMSW
-
Arman Salim, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Federally qualified health center certification: CCN C71011
- Legal name
- BALDWIN FAMILY HEALTH CARE
- Doing business as
- EVART PUBLIC SCHOOLS CAHC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 5, 2024
- Last certification
- Jan 5, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 1, 1975 in MI
- Enrollment address
- 321 N Hemlock St
Evart, MI 49631-9588
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Pamela Panetta |
Corporate Director |
Oct 1, 2018 | |
| Ashley Hawkins |
Corporate Director |
Jan 23, 2023 | |
| Susan Olds |
Corporate Director |
Jul 25, 2019 | |
| Mary Martin |
Corporate Director |
Jul 25, 2022 | |
| Corey Vanfleet |
Corporate Director |
May 1, 1996 | |
| Robert Fisher |
Corporate Director |
Apr 1, 1992 | |
| Eric Davidson |
Corporate Director |
Sep 1, 1986 | |
| Julie Tatko |
Corporate Officer |
Sep 1, 2020 | |
| W-2 Managing Employee |
Sep 1, 2020 | ||
| Mason Husby |
Corporate Officer |
Aug 1, 2018 | |
| Marissa Kelly |
Corporate Director |
Dec 1, 2021 | |
| Bruce Whitney |
Corporate Director |
Jan 23, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20240108005544 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 1153215413 | Practice locations: Evart, MI |
National Provider Directory
- Part of
- Rowland Family Health C
Locations
321 N Hemlock St
Evart, MI 49631
Phone (231) 734-4219
225 W Church Ave
Reed City, MI 49677
Phone (231) 791-7435
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
321 N Hemlock St
Evart, MI 49631-9588
Mailing address
520 Cobb St
Cadillac, MI 49601-2588
Phone (231) 876-6527
Other names
- Evart Public Schools CAHC
Other providers in Evart, MI
- Albert Baker
- Beemer Afc Homes Corp
- Bengry Pharmacy PC
- Benjamin L. Zarzecki DDS PLLC
- Mary Ann Dahlgren
- Brandy Darling
All providers in Evart, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.