JACQUELYN VANDER WALL MD. INC NPI 1386724375
Specialist in Irvine, CA

About JACQUELYN VANDER WALL MD. INC

Jacquelyn Vander Wall Md. Inc is a provider established in Irvine, California operating as a Specialist. The NPI number of Jacquelyn Vander Wall Md. Inc is 1386724375 and was assigned on October 2006. The practitioner's primary taxonomy code is 174400000X with license number G065045 (CA). The provider is registered as an organization and their NPI record was last updated 7 years ago. Jacquelyn Vander Wall Md. Inc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Optumcare Medical Group. The authorized official of this NPI record is Jacquelyn Lee Vander Wall M.d. (Md)

NPI
1386724375
Provider NameJACQUELYN VANDER WALL MD. INC
Location Address11 TECHNOLOGY DR IRVINE, CA 92618
Location Phone(949) 923-3250
Mailing Address3460 KATELLA AVE LOS ALAMITOS, CA 90720
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameOPTUMCARE MEDICAL GROUP
Other Name TypeDoing Business As (3)
Enumeration Date10-16-2006
Last Update Date04-26-2016



The CLIA number of Jacquelyn Vander Wall Md. Inc is 05D0579395 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Jacquelyn Vander Wall Md. Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.



Primary Taxonomy

The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Taxonomy Code174400000X
ClassificationSpecialist
TypeOther Service Providers
License No.G065045
License StateCA
Taxonomy DescriptionAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Accepted Insurance

The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Business Address

JACQUELYN VANDER WALL MD. INC
11 TECHNOLOGY DR
IRVINE, CA
ZIP 92618
Phone: (949) 923-3250
Fax: (855) 812-5865

Get Directions


Mailing Address

JACQUELYN VANDER WALL MD. INC
3460 KATELLA AVE
LOS ALAMITOS, CA
ZIP 90720
Phone: (562) 594-6599
Fax: (562) 598-7116


Location Map

Authorized Official

The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

Authorized Official Name JACQUELYN LEE VANDER WALL M.D.
Authorized Official TitleMD
Authorized Official Phone(562) 594-6599

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1386724375 is:

CLIA Number05D0579395
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


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

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
00G65045GMEDICAID (05)CA
CB252872OTHER (01)CAMEDICARE
W18164MEDICARE ID-TYPE UNSPECIFIED (04)CAGROUP MEDICARE NUMBER
E80521MEDICARE UPIN (02)CA
WG65045GMEDICARE ID-TYPE UNSPECIFIED (04)CAINDIVIDUAL MEDICARE NUMBE

NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1386724375
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
231661428314
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 1 + 6 + 6 + 1 + 4 + 2 + 8 + 3 + 1 + 4 + 24 = 65
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 65 = 55

The NPI number 1386724375 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1538410352 PATRICK KEONI TABON PHARMD
Individual
Pharmacist11 TECHNOLOGY DR
IRVINE, CA 92618
(808) 203-4537
1821155326DR. TENGIS RIZNIS MD
Individual
Family Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(949) 923-3200
1699950097 NORRIS VIVATRAT M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(949) 923-3200
1932330453 KATE DO-QUYEN LE
Individual
Pharmacist11 TECHNOLOGY DR
IRVINE, CA 92618
(949) 453-4171
1447254792DR. JUAN MARIA CABRERA M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1417954306DR. RONALD LEE MD
Individual
Family Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1083607055DR. SUBRATO GHOSH MD
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1508847971DR. MELANIE R WOLF DO
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1841262763DR. FRANCISCO S PEREZ M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1083689129DR. PARAG SHARMA M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1083675821 FARIDEH FARID BAHRAMI RNP
Individual
Nurse Practitioner11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1184688475DR. KAMBIZ V KARIMI M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1164477576 SALLY BETH KEENER NP
Individual
Nurse Practitioner11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1912944166DR. SARA SOOHEE KIM M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1922049188DR. OWRANG DASTMALCHI D.O.
Individual
Hospitalist11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1386688471DR. THUY ADRIANNE NGUYEN D.O.
Individual
Family Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1770528515DR. VIET HOANG NGUYEN D.O.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1407892490DR. SIAMAK N NABILI M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1780690131DR. SHAHAB ZAHED MD
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764
1689762197DR. BENHOOR KHALPARI M.D.
Individual
Internal Medicine11 TECHNOLOGY DR
IRVINE, CA 92618
(855) 206-6764

Frequently Asked Questions

What is JACQUELYN VANDER WALL MD. INC NPI number?

The NPI number assigned to JACQUELYN VANDER WALL MD. INC is 1386724375, registered as an "organization" on October 16, 2006

Where is JACQUELYN VANDER WALL MD. INC located?

The provider is located at 11 Technology Dr Irvine, Ca 92618 and the phone number is (949) 923-3250

What kind of medical provider is JACQUELYN VANDER WALL MD. INC?

This medical organization specializes in Specialist

What insurance does JACQUELYN VANDER WALL MD. INC accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.

What is JACQUELYN VANDER WALL MD. INC CLIA number?

The provider's CLIA number is 05D0579395 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

How do I update my NPI information?

The NPI record of JACQUELYN VANDER WALL MD. INC was last updated on October 16, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected]
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us at: [email protected]