NPIMap

Organization Active NPI

Mark H Mazur MD & Barry Statner MD a Professional Corporation

  • Infectious Disease Physician
  • Thousand Oaks, CA
National Provider Identifier
1376631341
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
MARK H MAZUR MD & BARRY STATNER MD A PROFESSIONAL CORPORATION
Practice address
375 Rolling Oaks Dr Ste 210
Thousand Oaks, CA 91361-1028
Phone
(805) 495-1073
Fax
(805) 495-5836
NPI assigned
Oct 11, 2006
Last updated
Jul 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Mark H Mazur, MDNPI 1245328228
Title
President
Phone
(805) 495-1073

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

375 Rolling Oaks Dr Ste 210
Thousand Oaks, CA 91361-1028

Mailing address

2220 Lynn Rd
Suite 301
Thousand Oaks, CA 91360-8005
Phone (805) 495-1073

Other identifiers 2

IdentifierTypeStateIssuer
GR0078460MedicaidCA
ZZZ62326ZOtherCABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050524001355 CA Part B Supplier - Clinic/Group Practice 1254373806 Receives reassigned benefits from 21 practitioners
Practice locations: Pasadena, CA; Walnut Creek, CA; Thousand Oaks, CA; Temecula, CA; Santa Clarita, CA; Roseville, CA; Poway, CA; Murrieta, CA…

National Provider Directory

National Provider Directory

Locations

2360 E Bidwell St
Folsom, CA 95630

2360 E Bidwell St
Ste 107
Folsom, CA 95630
Phone (916) 220-2951

4037 Hardwick St
Lakewood, CA 90712

1174 Castro St
Ste 150
Mountain View, CA 94040

301 S Fair Oaks Ave
Ste 304
Pasadena, CA 91105
Phone (626) 960-2711

15706 Pomerado Rd
Ste S202
Poway, CA 92064

9050 Fairway Dr
Ste 125
Roseville, CA 95678

24355 Lyons Ave
Ste 160
Santa Clarita, CA 91321
Phone (661) 600-9494

901 McClintock Dr
Ste 203
Burr Ridge, IL 60527

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)…

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1376631341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 LYNN RD",
            "address_2": "SUITE 301",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913608005",
            "telephone_number": "805-495-1073",
            "fax_number": "805-495-5836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 ROLLING OAKS DR STE 210",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611028",
            "telephone_number": "805-495-1073",
            "fax_number": "805-495-5836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK H MAZUR MD & BARRY STATNER MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "MAZUR",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-495-1073",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0078460",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ62326Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.