Boulder Community Health
Organization Active NPI Clinical Medical Laboratory · Longmont, CO
NPI 1992353064 · NPPES record last updated Aug 30, 2019
Key facts
- NPI
- 1992353064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- BOULDER COMMUNITY HEALTH
- Practice address
- 2101 Ken Pratt Blvd
Longmont, CO 80501-6567 - Phone
- (303) 442-2395
- Fax
- (303) 442-1073
- NPI assigned
- Aug 30, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- BOULDER COMMUNITY HEALTH
Authorized official
- Name
- Jay Pekarek
- Title
- Reimbursement Specialist
- Phone
- (303) 415-4233
Owners & managing parties with NPI records 5
-
Alyssa Snow Carlson, M.D.
Other NPIs on the same Medicare enrollment 33
Corporate family (same tax ID) 12
Related certifications (CCN) 1
Affiliated clinicians 720
-
Tara Adams, MSPAS, PA-C
-
Elizabeth Alaimo, DO
-
Kacie Lynne Albertsen, DNP, APRN
-
Ann Marie Albright, FNP-C
-
Jeska Albuisson, M.D.
-
Carl Kelly Aldin, MD
-
Leann Alland, DPM
-
Dawn E Ammon, PA
-
Maria T Anderson, MD
-
Karen M Andrews, MD
-
Jose Angel, MD
-
Kevin Arnold, M.D.
-
Erin Kathleen Atkinson, ARNP
-
Heather Baer, MD
-
Sarah M Bair, M.D.
Medicare Care Compare: Hospital
- Listed as
- Boulder Community Health
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D0515719 | Frontier Internal Medicine | Certificate of waiver | Apr 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
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
- Corporation · Non-profit
- Enrollment address
- 4747 Arapahoe Ave
Boulder, CO 80303-1131 - Hospital subgroups
- General
All disclosed owners & managing parties 26
| Name | Role | Since | Share |
|---|---|---|---|
| Perla Delgado |
Corporate Officer |
Jan 1, 2024 | |
| Robert Yates |
Corporate Officer |
Jan 1, 2024 | |
| Phillip P Distefano |
Corporate Officer |
Jan 1, 2017 | |
| Grant Besser |
Corporate Officer |
Oct 17, 2016 | |
| W-2 Managing Employee |
Oct 17, 2016 | ||
| Alyssa S Carlson |
Corporate Officer |
Nov 2, 2025 | |
| W-2 Managing Employee |
Nov 2, 2025 | ||
| George Karakehian |
Corporate Officer |
Jan 1, 2017 | |
| Elizabeth Cook |
Corporate Officer |
Jan 1, 2024 | |
| Susan Connelly |
Corporate Officer |
Jan 1, 2023 | |
| Lawrence Novissimo |
Corporate Officer |
Jul 4, 2021 | |
| W-2 Managing Employee |
Jul 4, 2021 | ||
| William a Munson |
Corporate Officer |
Mar 18, 2008 | |
| W-2 Managing Employee |
Mar 16, 2008 | ||
| Diana Verrilli |
Corporate Officer |
Jan 1, 2024 | |
| Jay Pekarek |
W-2 Managing Employee |
Nov 21, 2012 | |
| Teresa Cole |
Corporate Officer |
Jun 16, 2024 | |
| W-2 Managing Employee |
Jun 16, 2024 | ||
| Robert J Vissers |
Corporate Officer |
Jan 1, 2017 | |
| W-2 Managing Employee |
Jan 1, 2017 | ||
| John T Greff |
Corporate Officer |
Jan 1, 2018 | |
| Doug Abel |
Corporate Officer |
Jan 1, 2024 | |
| Valerie E Lipetz |
Corporate Officer |
Jan 1, 2024 | |
| Boulder Community Health |
Other | Jul 1, 1966 | |
| Joel R Montbriand |
Corporate Officer |
Jan 1, 2024 | |
| John Fleagle |
Corporate Officer |
Jan 1, 2024 | |
| Deborah S Lund |
Corporate Officer |
Jan 1, 2018 | |
| Jackie Attlesey-Pries |
Corporate Officer |
Sep 6, 2011 | |
| W-2 Managing Employee |
Sep 6, 2011 | ||
| Chris Hazlitt |
Corporate Officer |
Jan 1, 2024 | |
| Mardi Moore |
5% Or Greater Direct Ownership Interest |
Jan 1, 2019 | |
| Corporate Officer |
Jan 1, 2024 | ||
| Sarah E Meshak |
Corporate Officer |
Aug 31, 2009 | |
| W-2 Managing Employee |
Aug 31, 2009 | ||
| Nancy Stevens |
5% Or Greater Direct Ownership Interest |
Jan 1, 2019 | |
| Corporate Officer |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030902000042 | CO | Part a Provider - Hospital | 6800707233 |
34 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Michael Vongortler MD
- Part of
- Michael Vongortler MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
2101 Ken Pratt Blvd
Longmont, CO 80501-6567
Mailing address
4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-4700
Other names
- FRONTIER INTERNAL MEDICINE LAB
Other providers in Longmont, CO
- Boulder Community Health
- Boulder Community Health
- Boulder Community Health
- Boulder Community Health
- Boulder Community Health
- Boulder County Public Health
- Boulder County Public Health
- Boulder Medical Center, P.C.
- Boulder Plastic Surgery Prof LLC
- Boulder Plastic Surgery Prof LLC
All providers in Longmont, CO · Clinical Medical Laboratory in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.