NPIMap

Organization Active NPI

Thousand Oaks Pathology Associates Inc a Medical Group

  • Clinical Medical Laboratory
  • Thousand Oaks, CA
National Provider Identifier
1912930900
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
05D1022855 Issued in CA
Legal business name
THOUSAND OAKS PATHOLOGY ASSOCIATES INC A MEDICAL GROUP
Practice address
351 Rolling Oaks Dr
Suite 100
Thousand Oaks, CA 91361-1275
Phone
(805) 373-8582
Fax
(805) 373-0023
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Authorized official

Name
Eric Broxham, MDNPI 1124262506
Title
Authorized Official
Phone
(805) 373-8582

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 05D1022855 CA Primary

Addresses

Primary practice location

351 Rolling Oaks Dr
Suite 100
Thousand Oaks, CA 91361-1275

Mailing address

PO Box 39215
Los Angeles, CA 90039-2165
Phone (800) 288-8325

Other identifiers 1

IdentifierTypeStateIssuer
LAB22855FMedicaidCA

Other names 1

  • THOUSAND OAKS PATHOLOGY ASSOCIATES INC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050310000398 CA Part B Supplier - Independent Clinical Laboratory 8123072311 Practice locations: Thousand Oaks, CA

National Provider Directory

National Provider Directory

Locations

415 Rolling Oaks Dr
Ste 170
Thousand Oaks, CA 91361
Phone (805) 373-8582

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775001600000",
    "number": "1912930900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39215",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900392165",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 ROLLING OAKS DR",
            "address_2": "SUITE 100",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611275",
            "telephone_number": "805-373-8582",
            "fax_number": "805-373-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOUSAND OAKS PATHOLOGY ASSOCIATES INC A MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A",
        "authorized_official_last_name": "BROXHAM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "805-373-8582",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D1022855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB22855F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THOUSAND OAKS PATHOLOGY ASSOCIATES INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 1, 2026; 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.