DR. JESSICA WALL DIVINE M.D.
NPI 1184065930
Family Medicine in Santa Cruz, CA

Q: What is Jessica Divine's NPI number?

The NPI number for Jessica Divine is 1184065930. It was assigned to this individual provider in the NPPES registry on July 9, 2013. The provider is also known as Dr. Jessica Lauren Wall MD.

Q: What is Jessica Divine's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jessica Divine was last updated on February 19, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 09, 2013PECOS EnrolledAccepts Medicare Assignment

1080 EMELINE AVE, SANTA CRUZ, CA 95060(831) 454-4100(831) 454-4488 Get Directions Write a Review

NPPES record last updated: February 19, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 19, 2025, Jul 25, 2024, Jul 16, 2024 and 2 more (5 updates tracked since 2020).

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About Dr. Jessica Wall Divine M.d. NPPES

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

DR. JESSICA WALL DIVINE M.D. (NPI 1184065930) is an individual family medicine provider in Santa Cruz, California, licensed in California (145258) and active in the NPI registry since July 2013. She is enrolled in Medicare PECOS, maintains a secondary practice location in Folsom, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1184065930

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameDR. JESSICA WALL DIVINECredential: M.D.

Location Address1080 EMELINE AVESanta Cruz, CA 95060-1966

Mailing Address1080 Emeline AveSanta Cruz, CA 95060-1966 · (831) 454-4100

Phone(831) 454-4100

Fax(831) 454-4488

Sole ProprietorNo

Medical School CMSOtherGraduated 2013

Enumeration DateJuly 9, 2013

Last NPPES UpdateFebruary 19, 20255 updates tracked since enumeration

NPPES CertifiedFebruary 19, 2025

✔ NPI 1184065930 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in CA · 145258✔ Licensed in VA · 0116026459

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.

1080 EMELINE AVE, Santa Cruz, CA 95060

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Other Names 1

Former Name (1)Dr. Jessica Lauren Wall Md

Secondary Practice Location 1

Location 12575 E Bidwell St Ste 250Folsom, CA 95630-6447 · Phone (916) 817-3700

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jessica Wall Divine M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8022330059

PECOS Enrollment IDI20200604002644

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

56 services39 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

32 services26 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

19 services19 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.03 typical visit price

range $62.97 – $186.69

Typical copayment $24.00 (range $15.74 – $46.67)

Most-billed visit code 99203

Established Patient

$109.72 typical visit price

range $21.02 – $153.16

Typical copayment $27.43 (range $5.25 – $38.29)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

3 suppliers16 claims48 services$6.74 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

4 suppliers12 claims72 services$1.66 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

1 supplier13 claims13 services$10.79 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

2 suppliers21 claims21 services$26.76 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 20

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

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