NPIMap

Organization Active NPI

Community Memorial Health System

  • Multi-Specialty Clinic/Center
  • Port Hueneme, CA
National Provider Identifier
1659656775
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COMMUNITY MEMORIAL HEALTH SYSTEM
Practice address
321 E Port Hueneme Rd
Port Hueneme, CA 93041-3222
Phone
(805) 652-4267
Fax
(805) 488-8082
NPI assigned
Oct 20, 2011
Last updated
May 19, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY MEMORIAL HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Authorized official

Name
Mick Zdeblick
Title
Ceo
Phone
(805) 652-5011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

321 E Port Hueneme Rd
Port Hueneme, CA 93041-3222

Mailing address

5855 Olivas Park Dr
Ventura, CA 93003-7672
Phone (805) 667-2801

Other names 2

  • Community Memorial Hospital Former legal business name
  • Community Memorial Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040422001668 CA Part B Supplier - Clinic/Group Practice 9537155676 Receives reassigned benefits from 274 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ventura, CA; Port Hueneme, CA; Oxnard, CA; Camarillo, CA; Fillmore, CA; Ojai, CA
O20071219000370 CA Part A Provider - Hospital 9537155676 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ventura, CA; Camarillo, CA; Oxnard, CA; Port Hueneme, CA; Ojai, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659656775. Details of each certification follow.

Hospital certification: CCN 050394

Legal name
COMMUNITY MEMORIAL HEALTH SYSTEM
Doing business as
COMMUNITY MEMORIAL HOSPITAL - VENTURA
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 5, 2026
Beds
242
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 13, 1933 in CA
Enrollment address
147 N Brent St
Ventura, CA 93003-2809
Main/Primary Hospital Location
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 21

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

View all 21

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Memorial Hospital - VenturaCCN 050394 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
05D2041884Community Memorial Hospital Ctr for Family HLTH -321 E Port Hueneme Rd, Port Hueneme, CA 93041Provider-performed microscopyOct 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Health System22 organizations share this tax ID, including this one
Part of
Community Memorial Health System

Other organizations with this tax ID 21

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

View all 21

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Jeffrey C Brackett Individual Corporate DirectorDirector/Officer Nov 1, 2017
Deborah E Carlson Individual Corporate Director Jan 1, 2019
William J Kearney Individual Corporate OfficerBoard Member Jan 1, 2014
Martin a Pops Individual Corporate Director Nov 28, 2007
Jeffrey D Paul Individual Corporate OfficerBoard Member Jan 1, 2014
Celina Zacarias Individual Corporate Director Jan 1, 2021
Michael Zdeblick Individual Corporate OfficerChief Executive Officer Jan 9, 2023
Corporate DirectorCeo and President Jan 9, 2023
W-2 Managing Employee Jan 9, 2023
Miranda Margetts Individual Corporate Director Jan 1, 2021
Lydia Hopps Individual Corporate DirectorDirector/Officer Nov 1, 2017
Christopher D Johnson Individual Corporate Director Jan 1, 2021
Jeffrey W Loebl Individual Corporate Director Jan 1, 2021
Gary L Wolfe Individual Corporate Director Nov 28, 2007
Judith H Norris Individual Corporate Director Jan 1, 2021
David Fukutomi Individual Corporate DirectorDirector/Officer Nov 1, 2017
Richard R Rush Individual Corporate OfficerBoard Member Jan 1, 2014
Elizabeth H Pavlov Individual Corporate Director Jan 1, 2021
John J Hammer Individual Corporate Director Nov 28, 2007
Michael D Bradbury Individual Corporate Director Nov 28, 2007
Catherine Dixon Ferguson Individual Corporate Director Jan 1, 2021
Timothy J Gallagher Individual Corporate Director Nov 28, 2007
Frederick T Muegenburg Individual Corporate Director Nov 28, 2007
Community Memorial Health System Organization, Ventura, CA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Linda Pettit Individual Corporate Director Jan 1, 2021

Owners & managing parties with NPI records 11

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

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

Affiliated clinicians 565

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

View all 565

NPI Registry JSON

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1659656775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 OLIVAS PARK DR",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930037672",
            "telephone_number": "805-667-2801",
            "fax_number": "805-667-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 E PORT HUENEME RD",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930413222",
            "telephone_number": "805-652-4267",
            "fax_number": "805-488-8082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY MEMORIAL HEALTH SYSTEM",
        "enumeration_date": "2011-10-20",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "ZDEBLICK",
        "authorized_official_first_name": "MICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "805-652-5011"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Memorial Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Community Memorial Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Community Memorial Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Hueneme, CA

Sources for this page

Verify at the official NPI Registry.