Lifelong Medical Care
Organization Active NPI Community Health Clinic/Center · Oakland, CA
NPI 1619145307 · NPPES record last updated Mar 31, 2022
Key facts
- NPI
- 1619145307
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- LIFELONG MEDICAL CARE
- Practice address
- 9933 Macarthur Blvd
Oakland, CA 94605-4853 - Phone
- (510) 981-4122
- NPI assigned
- Feb 14, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LIFELONG MEDICAL CARE
Authorized official
- Name
- Mr. Marty Lynch, PH.D.
- Title
- Ceo
- Phone
- (510) 981-4123
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 43
Practitioners 76
-
Nicole Atme-Bahrani, FNP
-
Mariam Attawia, NP
-
Dipti Surendra Barot, M.D.
-
Jessica D Bigler Uhl, LCSW
-
Karen Carothers, MD
-
David A Chen, M.D.
-
Ji Jill Chen, M.D.
-
Anya Desai, MD
-
Jan Diamond, MD
-
Linda K. Frankel, M.D.
-
Douglas Frey, MSN, NP-C, FNP
-
Eric Arthur Fuller, DPM
-
Samantha Theresa Garey, PA-C, MPH
-
Sunakshi Garg, DPM
-
Dana Gersten, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Federally qualified health center certification: CCN 051161
- Legal name
- LIFELONG MEDICAL CARE
- Doing business as
- LIFELONG MEDICAL CARE - HOWARD DANIEL CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 19, 2008
- Last certification
- Nov 19, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 21, 1978 in CA
- Enrollment address
- 9933 Macarthur Blvd
Oakland, CA 94605-4853
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Phil Kamlarz |
Corporate Director |
Feb 18, 2020 | 7.14% |
| John Jenkins |
Corporate Director |
Feb 18, 2020 | 7.14% |
| Janet M Howley |
Corporate Director |
Sep 1, 2001 | 7.14% |
| Edgar Quiroz |
Corporate Director |
Feb 18, 2020 | 7.14% |
| Kevin Williams |
Corporate Director |
Jan 1, 2007 | 7.14% |
| Martin Lynch |
5% Or Greater Direct Ownership Interest |
Jan 1, 2020 | |
| Corporate Officer |
Jan 1, 2020 | 7.14% | |
| Operational/Managerial Control |
Jan 1, 2020 | ||
| Ronald Adler |
Corporate Director |
Jul 1, 1996 | 7.14% |
| Patricia C Carson-Sussman |
Corporate Director |
Jan 1, 2005 | 7.14% |
| Gloria Flores-Garcia |
Corporate Director |
Oct 1, 2005 | 7.14% |
| Judith Turiel |
Corporate Director |
Dec 1, 1990 | 7.14% |
| Stephen Fleischer-Ihn |
Corporate Director |
May 7, 2018 | |
| James Johnson |
Corporate Director |
Mar 1, 2009 | 7.14% |
| Brent Copen |
Corporate Officer |
Jul 19, 2021 | |
| W-2 Managing Employee |
Jul 19, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080325000724 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 2062304538 | Practice locations: Oakland, CA |
National Provider Directory
- Tax ID family
- Lifelong Medical
- Part of
- Lifelong Medical
Locations
9933 MacArthur Blvd
Oakland, CA 94605
Phone (510) 568-3206
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | |||
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
9933 Macarthur Blvd
Oakland, CA 94605-4853
Mailing address
9933 Macarthur Blvd
Oakland, CA 94605-4853
Phone (510) 981-4122
Other names
- LifeLong Medical Care Howard Daniel Clinic
Other providers in Oakland, CA
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All providers in Oakland, CA · Community Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.