NPIMap

Organization Active NPI

Lifelong Medical Care

  • Family Medicine Physician
  • Oakland, CA
National Provider Identifier
1376931295
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFELONG MEDICAL CARE
Practice address
386 14TH St
Oakland, CA 94612-3211
Phone
(510) 981-4100
NPI assigned
Dec 30, 2014
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFELONG MEDICAL CAREAs reported in NPPES

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. Martin Lynch, PHD
Title
Chief Executive Officer
Phone
(510) 981-4123

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

386 14TH St
Oakland, CA 94612-3211

Mailing address

PO Box 11247
Berkeley, CA 94712-2247
Phone (510) 981-4122

Other names 1

  • LifeLong TRUST Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150225000252 CA Part A Provider - Federally Qualified Health Center (FQHC) 2062304538 Practice locations: Oakland, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376931295. Details of each certification follow.

Federally qualified health center certification: CCN 751194

Legal name
LIFELONG MEDICAL CARE
Doing business as
LIFELONG TRUST HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 8, 2015
Last certification
Nov 8, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 1978 in CA
Enrollment address
386 14TH St
Oakland, CA 94612-3211

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
Part of
Lifelong Medical Center

Other organizations with this tax ID 43

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

View all 43

Locations

3451 E 12th St
Fl 2
Oakland, CA 94601
Phone (510) 535-3319

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
John Jenkins Individual Corporate Director Jun 1, 2012
Janet M Howley Individual Corporate Director Sep 1, 2001
Kevin Williams Individual Corporate Director Jan 1, 2013
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
Kimberly Ann Ceci Individual Corporate OfficerChief Medical Officer Sep 20, 2025
W-2 Managing EmployeeCmo Sep 30, 2025
James Johnson Individual Corporate Director Mar 1, 2009

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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": "1419897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1376931295",
    "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": "510-981-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 14TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123211",
            "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": "2014-12-30",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "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.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeLong TRUST Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "LifeLong TRUST Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.