NPIMap

Organization Active NPI

Southwest Volusia Healthcare Corporation

Doing business as AdventHealth Fish Memorial

  • General Acute Care Hospital
  • Orange City, FL
National Provider Identifier
1700978558
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4408 Issued in FL
Legal business name
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Doing business as
AdventHealth Fish Memorial
Practice address
1055 Saxon Blvd
Orange City, FL 32763-8468
Phone
(386) 917-5000
Fax
(386) 917-5019
NPI assigned
Sep 29, 2006
Last updated
Nov 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

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

Authorized official

Name
Kenneth Zill
Title
Chief Financial Officer
Phone
(407) 488-7815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 4408 FL Primary

Addresses

Primary practice location

1055 Saxon Blvd
Orange City, FL 32763-8468

Mailing address

770 W Granada Blvd Ste 203
Ormond Beach, FL 32174-5179
Phone (386) 231-4252

Other identifiers 2

IdentifierTypeStateIssuer
010182600MedicaidFL
318OtherFLBLUE CROSS FLORIDA

Other names 1

  • AdventHealth Fish Memorial Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other HIH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081028000553 FL Part A Provider - Hospital 0446153308 1 other NPI on this enrollment
Practice locations: Deltona, FL; Orange City, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700978558. Details of each certification follow.

Hospital certification: CCN 100072

Legal name
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Doing business as
ADVENTHEALTH FISH MEMORIAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 29, 2008
Beds
175
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in FL
Enrollment address
1055 Saxon Blvd
Orange City, FL 32763-8468
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Adventhealth Fish MemorialCCN 100072 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Florida Hospital Healthcare Partners Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 34

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

NameRoleSinceShare
Ralph Patterson Individual Corporate DirectorDirector Sep 13, 2007
Kurt H Bowman Individual Corporate DirectorDirector Jan 1, 2021
Debora H Thomas Individual Corporate OfficerAssistant Secretary Aug 24, 2023
Douglas Hilliard Individual Corporate DirectorDirector Aug 21, 2025
Jeffrey Graff Individual Corporate OfficerAssistant Secretary Sep 11, 2014
Samuel M Edwards Individual Corporate DirectorDirector Dec 12, 2024
Maria Rodriguez Individual Corporate DirectorDirector Apr 4, 2024
Rajiv Bahl Individual Corporate DirectorDirector Mar 24, 2023
Diane Godfrey Individual Corporate OfficerAssistant Secretary Jan 1, 2026
Jennifer Ambs Individual Corporate OfficerTreasurer Feb 20, 2025
Derek C Jackson Individual Corporate DirectorDirector Apr 3, 2025
Jeff L Ritchey Individual Corporate DirectorDirector Sep 17, 2015
Robert Deininger Individual Corporate OfficerAssistant Secretary, Chair Jun 13, 2025
Corporate DirectorDirector Jun 13, 2025
Curtis Robinson Individual Corporate DirectorDirector Jul 2, 2026
Kenneth Zill Individual Contracted Managing Employee Oct 21, 2025
Corporate OfficerTreasurer Sep 20, 2025
Operational/Managerial ControlCfo Oct 21, 2025
Marisa Farabaugh Individual Corporate OfficerAssistant Secretary Apr 9, 2026
Michael Saunders Individual Corporate OfficerAssistant Secretary Feb 22, 2007
John Wanamaker Individual Corporate DirectorDirector Sep 11, 2014
Craig Baker Individual Corporate DirectorDirector Nov 3, 2023
Francis Owens Individual Corporate DirectorDirector Feb 20, 2026
Adventist Health System Sunbelt Healthcare Corporation Organization, Altamonte Springs, FL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Aug 21, 1998 100%
Amanda Brady Individual Corporate OfficerAssistant Secretary Feb 27, 2020
Shrish Calla Individual Corporate DirectorDirector Feb 22, 2018
Toni Berrios Individual Corporate OfficerAssistant Secretary Aug 25, 2022
Haney Vincent Individual Corporate OfficerAssistant Secretary Dec 9, 2021
Douglas Pytlinski Individual Corporate OfficerAssistant Secretary Apr 9, 2026
Lorenzo Brown Individual Corporate OfficerVice Chair Apr 3, 2025
Corporate DirectorDirector Jun 9, 2016
David L Huffman Individual Corporate OfficerAssistant Secretary Feb 27, 2020
Robert C Foltz Individual Corporate OfficerAssistant Secretary Sep 11, 2014
Patricia Northey Individual Corporate DirectorDirector Sep 13, 2007
Lynn Addiscott Individual Corporate OfficerAssistant Secretary Aug 18, 2005
Beverly Morgan Individual Corporate OfficerAssistant Secretary Aug 21, 2025
Adventist Health System Sunbelt Inc Organization, Altamonte Springs, FL Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 21, 1998 100%
Eric Lunde Individual Contracted Managing Employee Feb 9, 2025
Corporate OfficerVice Chairperson Sep 26, 2022
Corporate DirectorDirector Sep 26, 2022
Operational/Managerial ControlCeo Feb 9, 2025

Owners & managing parties with NPI records 5

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

Facilities with the same owner 88

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

View all 88

Practitioners & affiliated clinicians

Practitioners 5

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.

Affiliated clinicians 669

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

View all 669

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1700978558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 W GRANADA BLVD STE 203",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745179",
            "telephone_number": "386-231-4252",
            "fax_number": "386-676-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 SAXON BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638468",
            "telephone_number": "386-917-5000",
            "fax_number": "386-917-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST VOLUSIA HEALTHCARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "ZILL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "407-488-7815"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "4408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010182600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FLORIDA",
            "identifier": "318",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AdventHealth Fish Memorial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange City, FL

Sources for this page

Verify at the official NPI Registry.