Individual provider Active NPI

Kimberly L Mazur, MD

  • Internal Medicine Physician
  • Atlantic City, NJ
National Provider Identifier
1649200106
Registry record updated Sep 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA05995100 Issued in NJ
Practice address
1401 Atlantic Ave
Suite 2800
Atlantic City, NJ 08401-7022
Phone
(609) 441-8036
Fax
(609) 572-6021
NPI assigned
Jul 3, 2006
Last updated
Sep 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA05995100 NJ Primary

Addresses

Primary practice location

1401 Atlantic Ave
Suite 2800
Atlantic City, NJ 08401-7022

Mailing address

1401 Atlantic Ave
Suite 2800
Atlantic City, NJ 08401-7022
Phone (609) 441-8036

Other identifiers 1

IdentifierTypeStateIssuer
5614104MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050907000041 NJ Practitioner - Internal Medicine 8325070766 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1401 Atlantic Ave
Suite 2600
Atlantic City, NJ 08401-7027
Phone (609) 572-6055

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA05995100NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group, PA CurrentSince Dec 19, 2010 Accepting new patients
Atlanticare Health Services Inc. CurrentSince Oct 29, 2017 Accepting new patients
Atlanticare Physician Group PA CurrentSince Dec 19, 2010 Accepting new patients
Atlanticare Health Services, Inc. Current Accepting new patients
Atlanticare Health Services, Inc. CurrentSince Oct 29, 2017 Accepting new patients
Atlanticare Regional Medical Center Past Accepting new patients
The Cooper Health System Past Accepting new patients

Locations

1401 Atlantic Ave
Ste 2600
Atlantic City, NJ 08401
Phone (609) 441-8036

1401 Atlantic Ave
Ste 2800
Atlantic City, NJ 08401
Phone (609) 441-8036

1925 Pacific Ave
Atlantic City, NJ 08401
Phone (609) 441-8023

54 W Jimmie Leeds Rd
Ste 8
Galloway, NJ 08205
Phone (609) 404-7300

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

65 W Jimmie Leeds Rd
Pomona, NJ 08240
Phone (609) 484-6414

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410393600000",
    "number": "1649200106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 ATLANTIC AVE",
            "address_2": "SUITE 2800",
            "city": "ATLANTIC CITY",
            "state": "NJ",
            "postal_code": "084017022",
            "telephone_number": "609-441-8036",
            "fax_number": "609-572-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 ATLANTIC AVE",
            "address_2": "SUITE 2800",
            "city": "ATLANTIC CITY",
            "state": "NJ",
            "postal_code": "084017022",
            "telephone_number": "609-441-8036",
            "fax_number": "609-572-6021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUR",
        "first_name": "KIMBERLY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2014-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA05995100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5614104",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlantic City, NJ

Sources for this page

Verify at the official NPI Registry.