County of Ventura
Organization Active NPI Federally Qualified Health Center (FQHC) · Oxnard, CA
NPI 1154600336 · NPPES record last updated Jul 19, 2024
Key facts
- NPI
- 1154600336
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- H80CS00247 (CA)
- Legal business name
- COUNTY OF VENTURA
- Practice address
- 2400 S C St
Oxnard, CA 93033 - Phone
- (805) 240-7000
- Fax
- (805) 486-0396
- NPI assigned
- Aug 5, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- VENTURA COUNTY MEDICAL CENTER
Authorized official
- Name
- Theresa Cho, MD
- Title
- Director
- Phone
- (805) 677-5290
Owners & managing parties with NPI records 2
-
Theresa Cho, M.D.
-
John Fankhauser, M.D.
Owned or controlled facilities with NPI records 18
Other NPIs with the same Medicare PAC ID 20
Corporate family (same tax ID) 22
Practitioners 340
-
Sohail Abdi-Moradi, M.D.
-
Levana Adato, LCSW
-
Afshin Ahoubim, M.D
-
Anne Akhimien, MD
-
Melissa Hansen Ambrosio, PA-C
-
Asad Amir, M.D.
-
Alejandro Andrade, M.D.
-
Lucy Maribel Andrade, LCSW
-
David Araujo, M.D.
-
Julianne Marie Awrey, M.D.
-
Michelle Beth Azimov, M.D.
-
Ravinder S Bajwa, MD
-
Nell Wheeler Baldwin, M.D.
-
Melissa Lee Barger, M.D.
-
Erin Barletta, MD
-
Linda Dianna Basquez, FNP
-
Mounir Belcadi, MD
-
Emily Suzanne Benson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Federally qualified health center certification: CCN 551131
- Legal name
- COUNTY OF VENTURA
- Doing business as
- LAS ISLAS MOBILE MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 2, 2012
- Last certification
- Apr 2, 2012
- Ownership / control type
- For profit – corporation
- Organization structure
- Government · Proprietary
- Enrollment address
- 2400 S C St
Oxnard, CA 93033-4555
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Theresa Lynn Cho |
Corporate Director |
May 1, 2024 | |
| W-2 Managing Employee |
May 1, 2024 | ||
| John Fankhauser |
Corporate Officer |
May 1, 2024 | |
| W-2 Managing Employee |
May 1, 2024 | ||
| Tracy Champan |
Corporate Director | Jun 25, 2024 | |
| W-2 Managing Employee |
Jun 25, 2024 |
All facility ownership & control disclosures 18
| Facility | Type | Role | Since |
|---|---|---|---|
| Ventura County Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 1966 Aug 18, 2010 |
| Magnolia Family Medical Group |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 8, 2013 Aug 18, 2010 |
| Conejo Valley Family Medical Group FQHC |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 29, 1994 |
| Las Islas Family Medical Group North |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 24, 2013 Aug 18, 2010 |
| Fillmore Family Medical Group |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 24, 2013 Aug 18, 2010 |
| John K Flynn Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 24, 2013 Aug 18, 2010 |
| Las Posas Family Medical Group |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Feb 19, 2014 Jan 1, 2013 |
| Sierra Vista Family Medical Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 8, 2013 Aug 18, 2010 |
| Santa Paula Hospital Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 24, 2013 Aug 18, 2010 |
| Pediatric Diagnostic Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 8, 2013 Aug 18, 2010 |
| Santa Paula West |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Mar 8, 2013 |
| Moorpark Family Medical Group |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2008 |
| Mandalay Bay Womens & Childrens |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 24, 2013 Aug 18, 2010 |
| Santa Paula Medical Clinic |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) | Jan 1, 2013 |
| West Ventura Medical Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 8, 2013 Aug 18, 2010 |
| Las Islas Family Medical Group II |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 24, 2013 Aug 18, 2010 |
| Ventura County Healthcare for the Homeless Program |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 24, 2013 |
| Magnolia West |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120402000295 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 7911810171 | Practice locations: Oxnard, CA |
National Provider Directory
- Tax ID family
- Penfield Mtu
- Part of
- Penfield Mtu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | H80CS00247 | CA | Yes |
Addresses
Primary practice location
2400 S C St
Oxnard, CA 93033
Mailing address
800 S Victoria Ave # L4615
Ventura, CA 93009-0001
Phone (805) 677-5210
Other names
- Las Islas Mobile
Other providers in Oxnard, CA
- County of Ventura
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All providers in Oxnard, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2024. 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.