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Alameda Health System

Organization Active NPI Federally Qualified Health Center (FQHC) · Oakland, CA

NPI 1548551997 · NPPES record last updated Apr 27, 2022

Key facts

NPI
1548551997
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
EXEMPT UNDER 12-35B (CA)
Legal business name
ALAMEDA HEALTH SYSTEM
Practice address
1411 E 31St St
Koret Buidling, 6TH Floor
Oakland, CA 94602-1018
Phone
(510) 437-4800
Fax
(510) 437-4187
NPI assigned
Apr 20, 2011
Organization subpart
No

Authorized official

Name
Kim Miranda
Title
Cfo
Phone
(510) 618-2147

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 38

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

View all 38

Practitioners 597

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 597

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Federally qualified health center certification: CCN 751835

Legal name
ALAMEDA HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 23, 2015
Last certification
Dec 23, 2015
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Incorporated
in CA
Enrollment address
1411 E 31St St
Oakland, CA 94602-1018

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Frederick J Devries
Individual 		Corporate Officer Oct 8, 2013
Corporate Director Oct 8, 2013
Anthony B Varni
Individual 		Corporate Director Mar 26, 2013
James Lugannani
Individual 		Corporate Director May 13, 2014
James E Jackson
Individual 		Corporate Officer May 14, 2012
W-2 Managing Employee May 14, 2012
Kinkini Banerjee
Individual 		Corporate Director Oct 8, 2013
Shari Johnson
Individual 		Corporate Officer
Chief Revenue Officer		 Oct 1, 2025
Michele Lawrence
Individual 		Corporate Director Nov 20, 2012

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
John George Psychiatric Hospital
San Leandro, CA · CCN 05S320		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1998
San Leandro Hospital Rehabilitation Unit
San Leandro, CA · CCN 05T320		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1998
Alameda Health System
Alameda, CA · CCN 050211		 Hospital Other (100%) May 1, 2014
Fairmont Hospital
San Leandro, CA · CCN 056479		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1998
Hayward Wellness Center
Hayward, CA · CCN 751807		 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Sep 18, 1998

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20160119000851 CA Part a Provider - Federally Qualified Health Center (FQHC) 3779494521 Practice locations: Oakland, CA

National Provider Directory

Tax ID family
Alameda Health Center (39 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator
Group: 193200000X MULTI-SPECIALTY GROUP		 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X EXEMPT UNDER 12-35B CA Yes

Addresses

Primary practice location

1411 E 31St St
Koret Buidling, 6TH Floor
Oakland, CA 94602-1018

Mailing address

15400 Foothill Blvd
San Leandro, CA 94578-1009
Phone (510) 895-7344

Other names

  • Highland Outpatient Clinic Doing business as

Other providers in Oakland, CA

All providers in Oakland, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.