CARL A MORTIZ JR MBR
NPI 1164048161
Family Medicine in Boulder, CO
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
Specialties & Licenses
Other Names 2
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Carl A Mortiz Jr Mbr is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Carl A Mortiz Jr Mbr, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, COFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
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.
Where is Crossroads Medical Center located?
Crossroads Medical Center is located at 2760 29th St Ste 2B, Boulder, CO 80301. The listed phone number is (303) 444-6400.
What is Crossroads Medical Center's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Crossroads Medical Center enrolled in Medicare?
Yes. Crossroads Medical Center is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Crossroads Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Crossroads Medical Center, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Crossroads Medical Center hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 06D0514918) is associated with this NPI, valid through January 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Crossroads Medical Center was last updated on September 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Carl A Mortiz Jr Mbr · NPI 1164048161
Family Medicine organization in Boulder, Colorado. Organization record, active in the CMS NPPES registry since June 25, 2020.
## Identity
- **NPI:** 1164048161 (Entity type: Organization)
- **Enumerated:** June 25, 2020
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Crossroads Medical Center
- **Also known as:** Crossroads Medical Center LLC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Lauren Jasilli, PRACTICE OWNER
## Practice location
- **Address:** 2760 29TH ST STE 2B, Boulder, CO 80301-1221
- **Phone:** (303) 444-6400 · **Fax:** (303) 444-6465
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 27, 2024
- **Other identifiers:** Medicaid 0126399 (CO)
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1164048161) · Data from the CMS NPPES public registry.