NPIMap

Organization Active NPI

Crossroads Healing Arts, LLC

  • Family Medicine Physician
  • Elkhart, IN
National Provider Identifier
1295028694
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1067015A Issued in IN
Legal business name
CROSSROADS HEALING ARTS, LLC
Practice address
1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326
Phone
(574) 294-1883
Fax
(574) 295-1749
NPI assigned
May 18, 2011
Last updated
Feb 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2015

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

Authorized official

Name
Ms. Kelly J Boyer, WHCNPNPI 1962462689
Title
Nurse Practitioner/Owner
Phone
(574) 294-1883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 1067015A IN Primary
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0500X 02002929A IN
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LW0102X 71001272 IN

Addresses

Primary practice location

1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326

Mailing address

1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326
Phone (574) 294-1883

National Provider Directory

National Provider Directory

Locations

1004 Parkway Ave
Ste C
Elkhart, IN 46516
Phone (574) 294-1883

56218 Parkway Ave
Ste C
Elkhart, IN 46516

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1295028694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 PARKWAY AVE",
            "address_2": "SUITE C",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169326",
            "telephone_number": "574-294-1883",
            "fax_number": "574-295-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 PARKWAY AVE",
            "address_2": "SUITE C",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169326",
            "telephone_number": "574-294-1883",
            "fax_number": "574-295-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS HEALING ARTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "574-294-1883",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "WHCNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "1067015A",
            "primary": true
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "IN",
            "license": "02002929A",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IN",
            "license": "71001272",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.