NPIMap

Organization Active NPI

Boulder Community Health

Doing business as Community Medical Center

  • Emergency Care Clinic/Center
  • Lafayette, CO
National Provider Identifier
1669020731
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
Legal business name
BOULDER COMMUNITY HEALTH
Doing business as
Community Medical Center
Practice address
1000 W South Boulder Rd
Lafayette, CO 80026-2752
Phone
(303) 415-4300
NPI assigned
Aug 30, 2019
Last updated
Aug 30, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BOULDER COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Authorized official

Name
Jay Pekarek
Title
Reimbursement Specialist
Phone
(303) 415-4233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X Primary

Addresses

Primary practice location

1000 W South Boulder Rd
Lafayette, CO 80026-2752

Mailing address

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-4700

Other names 1

  • COMMUNITY MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669020731. 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
06D0510935Community Medical Center Emergency Department1000 W South Boulder Rd, 1St Floor, Lafayette, CO 80026AccreditationNov 28, 2027

National Provider Directory

National Provider Directory
Part of
The Community Hospital

Member organizations 7

Organizations listed as members of this organization in the National Provider Directory.

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

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": "1567123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567123200000",
    "number": "1669020731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 ARAPAHOE AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031131",
            "telephone_number": "303-415-4700",
            "fax_number": "303-415-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W SOUTH BOULDER RD",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800262752",
            "telephone_number": "303-415-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOULDER COMMUNITY HEALTH",
        "enumeration_date": "2019-08-30",
        "last_updated": "2019-08-30",
        "status": "A",
        "authorized_official_last_name": "PEKAREK",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "REIMBURSEMENT SPECIALIST",
        "authorized_official_telephone_number": "303-415-4233"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMMUNITY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, CO

Sources for this page

Verify at the official NPI Registry.