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Children'S Hospital & Research Center at Oakland

Organization Active NPI Student Health Clinic/Center · Oakland, CA

NPI 1982994869 · NPPES record last updated Sep 5, 2024

Key facts

NPI
1982994869
Entity type
Organization (NPI type 2)
Primary specialty
Student Health Clinic/Center 261QS1000X
License
140000015 (CA)
Legal business name
CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Practice address
2607 Myrtle St
Oakland, CA 94607-3415
Phone
(510) 428-3885
Fax
(510) 428-3840
NPI assigned
Apr 13, 2011
Organization subpart
Yes
Parent organization (as reported)
CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND

Authorized official

Name
Seth Goldberg, PSYD
Title
Director of Behavioral Health
Phone
(510) 428-3885

Owners & managing parties with NPI records 7

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 21

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

Affiliated clinicians 14

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

Medicare Care Compare: Hospital

Listed as
UCSF Benioff Children'S Hospital Oakland CCN 053301
Type
Childrens
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Hospital certification: CCN 053301

Legal name
CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Doing business as
UCSF BENIOFF CHILDRENS HOSPITAL OAKLAND
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Sep 1, 1983
Last certification
Jan 10, 2014
Beds
190
Ownership / control type
Private (not for profit)
Organization structure
Corporation · Non-profit
Incorporated
Apr 24, 1913 in CA
Enrollment address
747 52ND St
Oakland, CA 94609-1809
Other Hospital Practice Location
Hospital subgroups
Children’s

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Elisa Stad
Individual 		Corporate Director Mar 31, 2016
Thomas Bret
Individual 		Corporate Director Jan 1, 2016
Robert Scott Fries
Individual 		Corporate Officer
Cfo		 Dec 15, 2015
W-2 Managing Employee
Chief Financial Officer		 Dec 15, 2015
Timothy Kendall
Individual 		Corporate Director Jan 1, 2016
Carolyn B Klebanoff
Individual 		Corporate Director Dec 7, 2016
Lynne Benioff
Individual 		Corporate Director
Board Member		 Jan 1, 2014
Michael R Anderson
Individual 		Corporate Officer
President		 Dec 12, 2016
Robin Washington
Individual 		Corporate Director May 28, 2015
David J Durand
Individual 		W-2 Managing Employee
Chief Medical Officer		 Feb 13, 2013
Carrie Wheeler
Individual 		Corporate Officer Aug 25, 2014
Corporate Director Aug 25, 2014
Edward Penhoet
Individual 		Corporate Officer
Secretary		 Jan 1, 2015
Corporate Director
Secretary/Board Member		 Feb 24, 2011
Melissa Williams
Individual 		Corporate Director Mar 31, 2016
Ronald Alan Cohen
Individual 		Corporate Director Apr 1, 2018
University of California San Francisco
Organization · San Francisco, CA 		Other Jan 1, 2014
Mark Laret
Individual 		Corporate Director
Board Member		 Jan 1, 2014
Charles Cole
Individual 		Corporate Director Mar 31, 2016
Nancy Shibata
Individual 		W-2 Managing Employee
SVP Clinical Ops, Chief Nursing Off		 May 1, 2012
George Weiss
Individual 		W-2 Managing Employee
VP Ambulatory Services		 Dec 28, 2017
Valli Benesch
Individual 		Corporate Director Sep 29, 2016
Jeffrey Cheung
Individual 		Corporate Officer
Treasurer		 Jan 1, 2015
Jamie Phillips
Individual 		W-2 Managing Employee
Chief Operating Officer		 Apr 23, 2018
Jason Moment
Individual 		Corporate Director Jan 1, 2016
David Beier
Individual 		Corporate Director May 28, 2015
Louis Lavigne
Individual 		Corporate Director Sep 29, 2011
Samir Kaul
Individual 		Corporate Director Dec 6, 2017
Robert Pedrero
Individual 		Corporate Director Sep 24, 2017
Phyllis Weiss
Individual 		W-2 Managing Employee
VP, Human Resources		 Jan 8, 2016
John Protopappas
Individual 		Corporate Director Sep 24, 2017
Farah Champsi
Individual 		Corporate Director Jan 1, 2016
Shahan Soghikian
Individual 		Corporate Officer
Chair		 Jan 1, 2017
Corporate Director Mar 29, 2012
Talmadge E King
Individual 		Corporate Director May 26, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20121221000291 CA Part a Provider - Hospital 3678725660 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oakland, CA; Walnut Creek, CA; San Ramon, CA; Brentwood, CA

National Provider Directory

Tax ID family
Child Assessment and Transition Services Cats (22 organizations share this tax ID)
Part of
Child Assessment and Transition Services Cats

Locations

5714 Martin Luther King Jr Way
Oakland, CA 94609
Phone (510) 428-3429

5700 Martin Luther King Jr Way
Oakland, CA 94609
Phone (510) 428-3429

100 N Wiget Ln
Walnut Creek, CA 94598
Phone (530) 758-2324

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X 140000015 CA Yes

Addresses

Primary practice location

2607 Myrtle St
Oakland, CA 94607-3415

Mailing address

747 52ND Street
Oakland, CA 94609-1809
Phone (510) 428-3885

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 5, 2024.

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1982994869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 52ND STREET",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091809",
            "telephone_number": "510-428-3885",
            "fax_number": "510-428-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2607 MYRTLE ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946073415",
            "telephone_number": "510-428-3885",
            "fax_number": "510-428-3840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND",
        "enumeration_date": "2011-04-13",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "DIRECTOR OF BEHAVIORAL HEALTH",
        "authorized_official_telephone_number": "510-428-3885",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "CA",
            "license": "140000015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

All providers in Oakland, CA · Student Health Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.