CROSSROADS MEDICAL CENTER – NPI #1164048161
Family Medicine

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CROSSROADS MEDICAL CENTER is a provider located in BOULDER, CO. NPPES has assigned the NPI number 1164048161 to CROSSROADS MEDICAL CENTER on June 25, 2020. It is a Type-2 NPI, indicating this NPI number is associated with an organization. CROSSROADS MEDICAL CENTER is also known by the name CARL A MORTIZ JR MBR. This provider is also associated with 2 additional names listed below. The primary taxonomy selected by this provider is 207Q00000X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine.

The NPI profile was last updated on Sep 27, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CROSSROADS MEDICAL CENTER below.

NPI Profile for
CROSSROADS MEDICAL CENTER

NPI Number
1164048161
Enumeration Date

(about 6 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CROSSROADS MEDICAL CENTER
Other Name: CARL A MORTIZ JR MBR
Other name(s)
All associated names:
Other Name
CARL A MORTIZ JR MBR
Doing Business As (dba)
Crossroads Medical Center LLC
Primary location
2760 29TH ST STE 2B
BOULDER, CO 80301-1221
Phone: (303) 444-6400 Fax: (303) 444-6465
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
LAUREN JASILLI
PRACTICE OWNER
Phone: (303) 444-6400
Updated
Certification Date
Sep 27, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for CROSSROADS MEDICAL CENTER

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidCO0126399
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207Q00000X
- Family Medicine (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.