NPIMap

Organization Active NPI

Lifelong Medical Care

Doing business as Lifelong Medical Care- East Oakland

  • Geriatric Medicine (Family Medicine) Physician
  • Oakland, CA
National Provider Identifier
1154327138
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
140000538 Issued in CA
Legal business name
LIFELONG MEDICAL CARE
Doing business as
Lifelong Medical Care- East Oakland
Practice address
10700 Macarthur Blvd
Ste 14B
Oakland, CA 94605-5260
Phone
(510) 563-4300
NPI assigned
Jun 23, 2005
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mr. Marty Lynch, N/A
Title
Ceo
Phone
(510) 981-4100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 140000538 CA Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

10700 Macarthur Blvd
Ste 14B
Oakland, CA 94605-5260

Mailing address

PO Box 11247
Berkeley, CA 94712-2247
Phone (510) 981-4100

Other identifiers 1

IdentifierTypeStateIssuer
FHC70704FMedicaidCA

Other names 1

  • LIFELONG MEDICAL CARE- EAST OAKLAND Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100729000580 CA Part A Provider - Federally Qualified Health Center (FQHC) 2062304538 Practice locations: Oakland, CA
O20140519000059 CA Part A Provider - Federally Qualified Health Center (FQHC) 2062304538 Practice locations: Oakland, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1154327138. Details of each certification follow.

Federally qualified health center certification: CCN 551812

Legal name
LIFELONG MEDICAL CARE
Doing business as
LIFELONG MEDICAL CARE-EAST OAKLAND
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 1996
Last certification
Sep 12, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 1978 in CA
Enrollment address
10700 Macarthur Blvd
Ste 14B
Oakland, CA 94605-5260

Federally qualified health center certification: CCN 751101

Legal name
LIFELONG MEDICAL CARE
Doing business as
LIFELONG MEDICAL CARE EASTMONT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2014
Last certification
May 23, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1996 in CA
Enrollment address
7200 Bancroft Ave 125a
Oakland, CA 94605-2457

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Lifelong Medical Center44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Jeanette L Alexich Individual Corporate DirectorBoard of Director Sep 1, 2001 6.25%
OtherBoard Member Nov 1, 2007 7.69%
Janet M Howley Individual Corporate OfficerPast Chair Sep 1, 2001 6.25%
OtherBoard Member Sep 1, 2001 7.69%
Kevin Williams Individual Corporate DirectorBoard of Director Jan 1, 2007 6.25%
OtherBoard Member Treasurer Jul 1, 2000 7.69%
Georgia Lacy Individual Corporate OfficerChair Jan 1, 2003 6.25%
OtherBoard Member Sep 1, 2001 7.69%
Martin Lynch Individual Corporate DirectorCeo/Executive Director Jul 1, 1996
Ronald Adler Individual Corporate OfficerVice Chair Nov 4, 2004 6.25%
OtherBoard Member Vice Chair Jan 1, 2007 7.69%
Patricia C Carson-Sussman Individual Corporate DirectorBoard of Director Jan 1, 2005 6.25%
OtherBoard Member Oct 1, 2005 7.69%
Dianna Chambers-Beamon Individual Corporate DirectorBoard of Director Jan 1, 2007 6.25%
Gloria Flores-Garcia Individual Corporate DirectorBoard of Director Oct 1, 2005 6.25%
OtherBoard Member Oct 1, 2005 7.69%
Judith Turiel Individual Corporate DirectorBoard of Director Dec 1, 1990 6.25%
OtherBoard Member Dec 1, 1990 7.69%
Stephen Fleischer-Ihn Individual Corporate DirectorDirector of Legal Services May 7, 2018
Nancy Threatt Individual Corporate OfficerSecretary Aug 1, 2003 6.25%
OtherBoard Member Past Chair Aug 1, 2003 7.69%
James Johnson Individual Corporate DirectorBoard of Director Mar 1, 2009 6.25%
OtherBoard Member Mar 1, 2009 7.69%
Brent Copen Individual Corporate OfficerChief Financial Officer Jul 19, 2021
W-2 Managing EmployeeCfo Jul 19, 2021
Corporate OfficerCfo Jul 19, 2021
Roberta Brooks Individual Corporate DirectorBoard of Director Nov 1, 2007 6.25%
OtherBoard Member Jan 1, 2005 7.69%
Nance Rosencranz Individual Corporate DirectorDirector of Strategic Planning Jan 31, 2005
Rick Clark Individual Corporate OfficerChief Financial Officer Sep 5, 2005 25%
Patricia Espinosa Individual W-2 Managing EmployeeController Mar 5, 2009

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": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1154327138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11247",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947122247",
            "telephone_number": "510-981-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 MACARTHUR BLVD",
            "address_2": "STE 14B",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946055260",
            "telephone_number": "510-563-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG MEDICAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-981-4100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "140000538",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70704F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFELONG MEDICAL CARE- EAST OAKLAND",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIFELONG MEDICAL CARE- EAST OAKLAND",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.