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Community Memorial Health System

Organization Active NPI Rural Health Clinic/Center · Santa Paula, CA

NPI 1689612798 · NPPES record last updated May 28, 2024

Key facts

NPI
1689612798
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
COMMUNITY MEMORIAL HEALTH SYSTEM
Practice address
242 E Harvard Blvd
Suite C
Santa Paula, CA 93060-3372
Phone
(805) 525-9595
Fax
(805) 525-6667
NPI assigned
Jun 2, 2006
Organization subpart
Yes
Parent organization (as reported)
COMMUNITY MEMORIAL HEALTH SYSTEM

Authorized official

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

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 21

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

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

Practitioners 190

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 190

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Rural health clinic certification: CCN 058609

Legal name
COMMUNITY MEMORIAL HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 16, 2004
Last certification
Jan 29, 2020
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Apr 13, 1933 in CA
Enrollment address
242 E Harvard Blvd
Ste C
Santa Paula, CA 93060-3372
Related CCNs
050394

All disclosed owners & managing parties 20

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 Director Feb 1, 2017
John V Hill
Individual 		Corporate Director Sep 3, 2004
William J Kearney
Individual 		Corporate Director Feb 1, 2017
Martin a Pops
Individual 		Corporate Director Feb 1, 2017
Lamar J Bushnell
Individual 		Corporate Director Feb 1, 2017
Jeffrey D Paul
Individual 		Corporate Director Feb 1, 2017
Edie Marshall
Individual 		Corporate Director Feb 1, 2017
Michael Zdeblick
Individual 		Corporate Officer
Chief Executive Officer		 Jan 9, 2023
W-2 Managing Employee Jan 9, 2023
Helen Petroff
Individual 		Corporate Director Feb 1, 2017
Roy a Schneider
Individual 		Corporate Director Feb 1, 2017
Lydia Hopps
Individual 		Corporate Director Feb 1, 2017
Gary L Wolfe
Individual 		Corporate Director Sep 3, 2004
David Fukutomi
Individual 		Corporate Director Feb 1, 2017
John W Russell
Individual 		Corporate Director Feb 1, 2017
Richard R Rush
Individual 		Corporate Director Feb 1, 2017
John J Hammer
Individual 		Corporate Director Sep 3, 2004
Michael D Bradbury
Individual 		Corporate Director Sep 3, 2004
Timothy J Gallagher
Individual 		Corporate Director Feb 1, 2017
Gregory Smith
Individual 		Corporate Director Sep 3, 2004
Frederick T Muegenburg
Individual 		Corporate Director Feb 1, 2017

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Memorial Hospital - Ventura
Ventura, CA · CCN 050394		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Community Memorial Continuing Care Center
Ojai, CA · CCN 056200		 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 1, 2005
Mar 4, 2025

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040817001490 CA Part a Provider - Rural Health Clinic 9537155676 1 other NPI on this enrollment
Practice locations: Santa Paula, CA

National Provider Directory

Tax ID family
Community Pharmacy (22 organizations share this tax ID)
Part of
Community Pharmacy

Locations

242 E Harvard Blvd
Ste C
Santa Paula, CA 93060
Phone (805) 525-9595

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: 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)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes
Urgent Care Clinic/Center 261QU0200X
VA Clinic/Center 261QV0200X

Addresses

Primary practice location

242 E Harvard Blvd
Suite C
Santa Paula, CA 93060-3372

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
RHM08609FMedicaidCA

Other names

  • Community Memorial Health Center Other name

Other providers in Santa Paula, CA

All providers in Santa Paula, CA · Rural Health Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.