NPIMap

Organization Active NPI

Lifelong Medical Care

Doing business as LifeLong Medical Care Howard Daniel Clinic

  • Community Health Clinic/Center
  • Oakland, CA
National Provider Identifier
1619145307
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
LIFELONG MEDICAL CARE
Doing business as
LifeLong Medical Care Howard Daniel Clinic
Practice address
9933 Macarthur Blvd
Oakland, CA 94605-4853
Phone
(510) 981-4122
NPI assigned
Feb 14, 2008
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. Marty Lynch, PH.D.
Title
Ceo
Phone
(510) 981-4123

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Community Health Clinic/Center 261QC1500X Primary

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 1

  • LifeLong Medical Care Howard Daniel Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080325000724 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 1619145307. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jul 21, 1978 in CA
Enrollment address
9933 Macarthur Blvd
Oakland, CA 94605-4853

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

Ownership & related parties

All disclosed owners & managing parties 13

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 DirectorTreasurer Feb 18, 2020 7.14%
John Jenkins Individual Corporate DirectorBoard Member Feb 18, 2020 7.14%
Janet M Howley Individual Corporate DirectorBoard Member Sep 1, 2001 7.14%
Edgar Quiroz Individual Corporate DirectorBoard Member Feb 18, 2020 7.14%
Kevin Williams Individual Corporate DirectorBoard Member Past Chair Jan 1, 2007 7.14%
Martin Lynch Individual 5% Or Greater Direct Ownership InterestCeo Jan 1, 2020
Corporate OfficerCeo Jan 1, 2020 7.14%
Operational/Managerial ControlCeo Jan 1, 2020
Ronald Adler Individual Corporate DirectorBoard Member Chair Jul 1, 1996 7.14%
Patricia C Carson-Sussman Individual Corporate DirectorBoard Member Jan 1, 2005 7.14%
Gloria Flores-Garcia Individual Corporate DirectorSecretary Oct 1, 2005 7.14%
Judith Turiel Individual Corporate DirectorBoard Member Dec 1, 1990 7.14%
Stephen Fleischer-Ihn Individual Corporate DirectorDirector of Legal Services May 7, 2018
James Johnson Individual Corporate DirectorBoard Member Mar 1, 2009 7.14%
Brent Copen Individual Corporate OfficerCfo Jul 19, 2021
W-2 Managing EmployeeCfo Jul 19, 2021

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": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1619145307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9933 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946054853",
            "telephone_number": "510-981-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9933 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946054853",
            "telephone_number": "510-981-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG MEDICAL CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFELONG MEDICAL CARE",
        "enumeration_date": "2008-02-14",
        "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": "510-981-4123",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeLong Medical Care Howard Daniel Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LifeLong Medical Care Howard Daniel Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.