Crossroads Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROSSROADS MEDICAL CENTER

Practice address

2760 29TH St Ste 2B
Boulder, CO 80301-1221

Phone

(303) 444-6400

Fax

(303) 444-6465

NPI assigned

Jun 25, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Lauren Jasilli, FNP-CNPI 1184228934

Title

Practice Owner

Phone

(303) 444-6400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Crossroads Medical Center LLC Doing business as
• Carl A Mortiz JR MBR Other name

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 3

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

• Lauren Jasilli, FNP-C

  • Family Medicine Physician
  • Boulder, CO
  • NPI 1184228934
  Medicare reassignment Care Compare group NPD Authorized official
• Carl Albert Moritz Jr., M.D.

  • Family Medicine Physician
  • Boulder, CO
  • NPI 1538128434
  Medicare reassignment Care Compare group NPD
• Rebecca Elyse Niemeyer, PA-C

  • Medical Physician Assistant
  • Brighton, CO
  • NPI 1275016503
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1164048161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 29TH ST STE 2B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011221",
            "telephone_number": "303-444-6400",
            "fax_number": "303-444-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 29TH ST STE 2B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011221",
            "telephone_number": "303-444-6400",
            "fax_number": "303-444-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-25",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "JASILLI",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "303-444-6400",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0126399",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Medical Center LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carl A Mortiz JR MBR",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Carl A Mortiz JR MBR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cheryl Claire Crosby, RN
• Kelly Sue Cross, LCSW
• Richard Cross, O.D.
• Teresa L Crossland, LPC 6101
• Aisling Crosson, MA, LPCC
• Cynthia Crouch, MS
• Rosa Crowe-Allison
• Rose Crowley, RN
• Jordan Crozier
• Katherine Crumpton, RN

• Family Medicine Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.