NPIMap

Organization Active NPI

Crossover Health Medical Group

  • Specialist
  • Fort Worth, TX
National Provider Identifier
1972121069
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CROSSOVER HEALTH MEDICAL GROUP
Practice address
4500 Mercantile Plaza Dr
Fort Worth, TX 76137-4225
Phone
(949) 891-0328
NPI assigned
Jul 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Authorized official

Name
Angie Sakioka
Title
HR Operations Specialist
Phone
(949) 891-0228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

4500 Mercantile Plaza Dr
Fort Worth, TX 76137-4225

Mailing address

101 W Avenida Vista Hermosa Ste 120
San Clemente, CA 92672-7707
Phone (949) 891-0328

Other names 1

  • Crossover @ High Crest Doing business as

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
45D2194167Crossover Health Medical Group, Apc4500 Mercantile Plaza Suite 204, Fort Worth, TX 76137Certificate of waiverSep 28, 2026

National Provider Directory

National Provider Directory
Tax ID family
Crossover Medical Group89 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1972121069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W AVENIDA VISTA HERMOSA STE 120",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926727707",
            "telephone_number": "949-891-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MERCANTILE PLAZA DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761374225",
            "telephone_number": "949-891-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSOVER HEALTH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-06",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "SAKIOKA",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "HR OPERATIONS SPECIALIST",
        "authorized_official_telephone_number": "949-891-0228"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossover @ High Crest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.