NPIMap

Organization Active NPI

Lifelong Medical Care

  • Family Medicine Physician
  • Pinole, CA
National Provider Identifier
1194198119
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFELONG MEDICAL CARE
Practice address
806 San Pablo Ave Ste 1
Pinole, CA 94564-2479
Phone
(510) 981-4100
NPI assigned
Nov 12, 2015
Last updated
Nov 8, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFELONG MEDICAL CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Authorized official

Name
Mr. Martin Lynch
Title
Chief Executive Officer
Phone
(510) 981-4123

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Dentist 122300000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

806 San Pablo Ave Ste 1
Pinole, CA 94564-2479

Mailing address

PO Box 11247
Berkeley, CA 94712-2247

Other names 1

  • LifeLong Medical Care Pinole Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170703001679 CA Part A Provider - Federally Qualified Health Center (FQHC) 2062304538 Practice locations: Pinole, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194198119. Details of each certification follow.

Federally qualified health center certification: CCN 751988

Legal name
LIFELONG MEDICAL CARE
Doing business as
LIFELONG MEDICAL CARE - PINOLE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 28, 2017
Last certification
Jun 28, 2017
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
806 San Pablo Ave
Pinole, CA 94564-2478

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 Jenkins Pediatric Center44 organizations share this tax ID, including this one
Part of
Lifelong Jenkins Pediatric Center

Other organizations with this tax ID 43

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

View all 43

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1690 San Pablo Ave
Pinole, CA 94564

806 San Pablo Ave
Ste 1
Pinole, CA 94564
Phone (510) 974-0473

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
Phil Kamlarz Individual Corporate Director Jun 1, 2016
Jeanette L Alexich Individual Corporate Director Sep 1, 2001
John Jenkins Individual Corporate Director Jun 1, 2012
Janet M Howley Individual Corporate Director Sep 1, 2001
Edgar Quiroz Individual Corporate Director May 1, 2015
Kevin Williams Individual Corporate Director Jan 1, 2013
Nance Rosencranz Individual Corporate Director Jan 31, 2005
Georgia Lacy Individual Corporate Director Jan 1, 2003
Martin Lynch Individual Corporate OfficerCeo Jul 1, 1996
Ronald Adler Individual Corporate Director Jan 1, 2013
Patricia C Carson-Sussman Individual Corporate Director Jan 1, 2005
Gloria Flores-Garcia Individual Corporate Director Oct 1, 2005
Judith Turiel Individual Corporate Director Dec 1, 1990
Nancy Threatt Individual Corporate Director Aug 1, 2003
James Johnson Individual Corporate Director Mar 1, 2009
Margaret Elizabeth Schilling Individual Corporate Director Sep 1, 2011
Brent Copen Individual Corporate OfficerCfo Jul 19, 2021
W-2 Managing EmployeeCfo Jul 19, 2021
Roberta Brooks Individual Corporate Director Nov 1, 2007

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": "1447286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1194198119",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 SAN PABLO AVE STE 1",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642479",
            "telephone_number": "510-981-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG MEDICAL CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFELONG MEDICAL CARE",
        "enumeration_date": "2015-11-12",
        "last_updated": "2019-11-08",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "510-981-4123",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeLong Medical Care Pinole Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "LifeLong Medical Care Pinole Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pinole, CA

Sources for this page

Verify at the official NPI Registry.