NPIMap

Organization Active NPI

Boulder Community Health

Doing business as Community Medical Assoc of BCH

  • Primary Care Clinic/Center
  • Boulder, CO
National Provider Identifier
1013564517
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BOULDER COMMUNITY HEALTH
Doing business as
Community Medical Assoc of BCH
Practice address
5495 Arapahoe Ave Ste 100
Boulder, CO 80303-1224
Phone
(303) 415-4250
Fax
(303) 440-9629
NPI assigned
Aug 20, 2019
Last updated
Jun 29, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BOULDER COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
William A Munson Jr.
Title
VP/Cfo
Phone
(303) 415-7433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

5495 Arapahoe Ave Ste 100
Boulder, CO 80303-1224

Mailing address

PO Box 9049
Boulder, CO 80301-9049
Phone (303) 415-4250

Other names 2

  • Community Medical Assoc of BCH Doing business as
  • Internal Medicine Associates Boulder Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030902000042 CO Part A Provider - Hospital 6800707233 34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20040123000284 CO Part B Supplier - Clinic/Group Practice 6800707233 Receives reassigned benefits from 316 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Erie, CO; Superior, CO; Longmont, CO; Lafayette, CO; Boulder, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013564517. Details of each certification follow.

Hospital certification: CCN 060027

Legal name
BOULDER COMMUNITY HEALTH
Doing business as
BOULDER COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 16, 2024
Beds
181
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
4747 Arapahoe Ave
Boulder, CO 80303-1131
Main/Primary Hospital Location
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 33

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

View all 33

Care Compare: Hospital

Medicare Care Compare
Listed as
Boulder Community HealthCCN 060027 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0697871Internal Medicine Associates Boulder5495 Arapahoe Ave, Ste 100, Boulder, CO 80303Certificate of waiverJun 20, 2028

National Provider Directory

National Provider Directory
Part of
BCH Physician Clinics

Interoperability endpoints

  • FHIR API: https://prevprox.bch.org/FHIRproxyPRD/api/FHIR/R4

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Perla Delgado Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Robert Yates Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Phillip P Distefano Individual Corporate OfficerBoard Member Jan 1, 2017
Grant Besser Individual Corporate OfficerVP Community Health & Engagement Oct 17, 2016
W-2 Managing EmployeeVP Community Health & Engagement Oct 17, 2016
Alyssa S Carlson Individual Corporate OfficerV.P. and Chief Medical Officer Nov 2, 2025
W-2 Managing EmployeeAd;MD; Nov 2, 2025
George Karakehian Individual Corporate OfficerBoard Member Jan 1, 2017
Elizabeth Cook Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Susan Connelly Individual Corporate OfficerBoard of Directors Member Jan 1, 2023
Lawrence Novissimo Individual Corporate OfficerVP Ambulatory Services Jul 4, 2021
W-2 Managing EmployeeVP Ambulatory Services Jul 4, 2021
William a Munson Individual Corporate OfficerChief Financial Officer (Cfo) an Mar 18, 2008
W-2 Managing EmployeeChief Financial Officer (Cfo) an Mar 16, 2008
Diana Verrilli Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Jay Pekarek Individual W-2 Managing EmployeeDelegated Official Nov 21, 2012
Teresa Cole Individual Corporate OfficerVP and Chief Information Officer Jun 16, 2024
W-2 Managing EmployeeVP and Chief Information Officer Jun 16, 2024
Robert J Vissers Individual Corporate OfficerCeo Jan 1, 2017
W-2 Managing EmployeeCeo Jan 1, 2017
John T Greff Individual Corporate OfficerBoard Member Jan 1, 2018
Doug Abel Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Valerie E Lipetz Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Boulder Community Health Organization, Boulder, CO Corporation, Non-profit Other Jul 1, 1966
Joel R Montbriand Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
John Fleagle Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Deborah S Lund Individual Corporate OfficerBoard Member Jan 1, 2018
Jackie Attlesey-Pries Individual Corporate OfficerVP Chief Nursing Officer Sep 6, 2011
W-2 Managing EmployeeVP Chief Nursing Officer Sep 6, 2011
Chris Hazlitt Individual Corporate OfficerBoard of Directors Member Jan 1, 2024
Mardi Moore Individual 5% Or Greater Direct Ownership InterestBoard Member Jan 1, 2019
Corporate OfficerBoard of Directors Member Jan 1, 2024
Sarah E Meshak Individual Corporate OfficerVP and General Counsel Aug 31, 2009
W-2 Managing EmployeeVP and General Counsel Aug 31, 2009
Nancy Stevens Individual 5% Or Greater Direct Ownership InterestBoard Member Jan 1, 2019
Corporate OfficerBoard of Directors Member Jan 1, 2024

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 2

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 720

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

View all 720

NPI Registry JSON

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

{
    "created_epoch": "1566259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1013564517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9049",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803019049",
            "telephone_number": "303-415-4250",
            "fax_number": "303-440-9629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5495 ARAPAHOE AVE STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031224",
            "telephone_number": "303-415-4250",
            "fax_number": "303-440-9629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOULDER COMMUNITY HEALTH",
        "enumeration_date": "2019-08-20",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "MUNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "303-415-7433",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Assoc of BCH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Medical Assoc of BCH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Internal Medicine Associates Boulder",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.