Healthcare Provider Details

I. General information

NPI: 1841122546
Provider Name (Legal Business Name): CROSSOVER HEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SEAPORT BLVD
BOSTON MA
02210-2031
US

IV. Provider business mailing address

200 SEAPORT BLVD
BOSTON MA
02210-2031
US

V. Phone/Fax

Practice location:
  • Phone: 971-500-2661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JENETTE HUNTER
Title or Position: SR. CREDENTIALING MANAGER
Credential: CPCS
Phone: 971-500-2661