CARL A MORTIZ JR MBR
NPI 1164048161
Family Medicine in Boulder, CO

Q: What is Crossroads Medical Center's NPI number?

The NPI number for Crossroads Medical Center is 1164048161. It was assigned to this organization in the NPPES registry on June 25, 2020. The provider is doing business as Crossroads Medical Center LLC. The provider is also known as Carl A Mortiz Jr Mbr.

Q: What is Crossroads Medical Center's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since June 25, 2020CLIA 06D0514918 · Waiver

2760 29TH ST STE 2B, BOULDER, CO 80301(303) 444-6400(303) 444-6465 Get Directions Write a Review

NPPES record last updated: September 27, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 27, 2024, Aug 16, 2023, Jul 5, 2023 and 1 more (4 updates tracked since 2020).

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About Carl A Mortiz Jr Mbr NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CARL A MORTIZ JR MBR (NPI 1164048161), doing business as Crossroads Medical Center Llc, is a healthcare organization registered as a family medicine in Boulder, Colorado and active in the NPI registry since June 2020. The organization holds a CLIA Waiver certificate valid through January 17, 2028 and lists Lauren Jasilli, Practice Owner, as its authorized official.

NPPES Registry Identity

NPI1164048161

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameCROSSROADS MEDICAL CENTER

Location Address2760 29TH ST STE 2BBoulder, CO 80301-1221

Mailing Address2760 29th St Ste 2bBoulder, CO 80301-1221 · (303) 444-6400 · Fax (303) 444-6465

Phone(303) 444-6400

Fax(303) 444-6465

Organization SubpartNo

Authorized OfficialLauren JasilliPractice Owner · (303) 444-6400

Enumeration DateJune 25, 2020

Last NPPES UpdateSeptember 27, 20244 updates tracked since enumeration

NPPES CertifiedSeptember 27, 2024

✔ NPI 1164048161 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2760 29TH ST STE 2B, Boulder, CO 80301

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Other Names 2

Other NameCarl A Mortiz Jr Mbr

Doing Business AsCrossroads Medical Center Llc

Other Identifiers 1

Medicaid0126399CO

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D0514918

Crossroad Medical Center · Boulder, CO

Active · expires Jan 17, 2028

CLIA Number06D0514918

Laboratory TypePhysician Office

Certificate Effective DateJanuary 18, 2026

Certificate Expiration DateJanuary 17, 2028

Laboratory DirectorCarl A. Moritz

Laboratory Phone(303) 444-6400

Laboratory LocationCrossroad Medical Center2760 29th St, Suite 2B, Boulder, CO 80301

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KOLBY SANDS FNP-C

Nurse Practitioner (Family)