MEDICARE: CROSSOVER HEALTH MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	193200000X	OTHER		NONMEDICARE

General Provider Information

NPI Number	:	1396608550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSOVER HEALTH MEDICAL GROUP

Provider Business Mailing Address
First Line	:	2821 SCOTT BLVD STE 2126
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-2549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 SCOTT BLVD STE 2126
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-2549
Country	:	US
Telephone Number	:	971-500-2661
Fax Number	:

Authorized Official
Title or Position	:	SR. MANAGER OF CREDENTIALING
Name	:	MRS. JENETTE HUNTER
Credential	:	CPCS
Telephone Number	:	971-500-2661

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “CROSSOVER HEALTH MEDICAL GROUP ” Practice Location

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