NPIMap

Organization Active NPI

Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saginaw, MI
National Provider Identifier
1972621753
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
501 Lapeer
Saginaw, MI 48607
Phone
(989) 753-6000
Fax
(989) 759-6454
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

501 Lapeer
Saginaw, MI 48607

Mailing address

501 Lapeer Ave
Saginaw, MI 48607-1203
Phone (989) 759-6464

Other identifiers 1

IdentifierTypeStateIssuer
0G36111OtherMI0G36111 MEDICARE PAY BILL TO

Other names 1

  • Great Lakes Bay Health Centers David R Gamez Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041007000550 MI Part A Provider - Federally Qualified Health Center (FQHC) 2466369046 1 other NPI on this enrollment
Practice locations: Saginaw, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972621753. Details of each certification follow.

Federally qualified health center certification: CCN 231902

Legal name
GREAT LAKES BAY HEALTH CENTERS
Doing business as
GREAT LAKES BAY HEALTH CENTERS DAVID R GAMEZ
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 3, 2004
Last certification
Nov 3, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1968 in MI
Enrollment address
501 Lapeer Ave
Saginaw, MI 48607-1203

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

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 13

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

View all 13

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 Director Jan 2, 2012
Suzanne Prich Individual Corporate Director May 1, 2014
Albert Martenis Individual Corporate Director Oct 1, 2013
Deborah Mack Individual Corporate Director Oct 1, 2014
Brenda M Coughlin Individual W-2 Managing Employee Dec 21, 2016
Timothy Zlomak Individual Corporate Director May 1, 2012
Jesus Hernandez Individual Corporate Director Jan 2, 2016
Tarshia Lewis Individual Corporate Director Oct 1, 2014
Dawn Christian Individual W-2 Managing EmployeeProvider Enrollment Coordinator Dec 21, 2016
Lisa Galonska Individual Corporate OfficerVice President Dec 1, 2011
Carni Applegate Individual Corporate Director Jan 2, 2016
Kellie Jo Treichel-Pergande Individual Corporate Director Jul 1, 2016
Sam Pruitt Individual Corporate Director 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.

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": "1972621753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAPEER AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486071203",
            "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": "501 LAPEER",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "48607",
            "telephone_number": "989-753-6000",
            "fax_number": "989-759-6454"
        }
    ],
    "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 PAY BILL TO",
            "identifier": "0G36111",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Bay Health Centers David R Gamez",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.