NPIMap

Organization Active NPI

Oaklandidence Opco, LLC

Doing business as Medical Hill Healthcare Center

  • Skilled Nursing Facility
  • Oakland, CA
National Provider Identifier
1982127338
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
OAKLANDIDENCE OPCO, LLC
Doing business as
Medical Hill Healthcare Center
Practice address
475 29TH St
Oakland, CA 94609-3510
Phone
(510) 832-3222
NPI assigned
Jul 18, 2017
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

475 29TH St
Oakland, CA 94609-3510

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Medical Hill Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170922001468 CA Part A Provider - Skilled Nursing Facility 7214201649 Practice locations: Oakland, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982127338. Details of each certification follow.

Skilled nursing facility certification: CCN 555254

Legal name
OAKLANDIDENCE OPCO, LLC
Doing business as
MEDICAL HILL HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 3, 1987
Last certification
Mar 14, 2024
Beds
124
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jul 17, 2017 in CA
Enrollment address
475 29TH St
Oakland, CA 94609-3510
Nursing home name
MEDICAL HILL HEALTHCARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Medical Hill Healthcare CenterCCN 555254 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 3, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
124120.4 residents per day on average
Chain
Pacs Group274 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0603397Medical Hill Healthcare Center475 29TH St, Oakland, CA 94609Certificate of waiverJul 29, 2028

National Provider Directory

National Provider Directory

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
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2017 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2020 50%
Corporate OfficerPresident/Ceo Jul 17, 2017
John T Mitchell Individual Corporate OfficerVice President/Asst Secretary Feb 10, 2021
Frederick G Apt Individual Corporate OfficerVice President/Asst Treasurer Feb 10, 2021
Andrew Snider Individual W-2 Managing EmployeeAdministrator Sep 1, 2017
Operational/Managerial ControlAdministrator Sep 1, 2017
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Bay Area Master Tenant LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Sep 1, 2017 100%
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2020 50%
Corporate OfficerVice President/Cfo/Secretary Jul 17, 2017

Facilities with the same owner 80

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 80

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1982127338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 29TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093510",
            "telephone_number": "510-832-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKLANDIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Hill Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.