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OPTUMCARE MEDICAL GROUP
NPI 1386724375
Specialist in Irvine, CA

Active since October 16, 2006CLIA 05D0722506 · Waiver
11 TECHNOLOGY DR, IRVINE, CA 92618(949) 923-3250(855) 812-5865 Get Directions Write a Review

NPPES record last updated: April 26, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Optumcare Medical Group NPPES

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

OPTUMCARE MEDICAL GROUP (NPI 1386724375) is a healthcare organization registered as a specialist in Irvine, California and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through June 9, 2028 and lists Jacquelyn Lee Vander Wall, Md, as its authorized official.

NPPES Registry Identity

NPI1386724375
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameJACQUELYN VANDER WALL MD. INC
Location Address11 TECHNOLOGY DRIrvine, CA 92618-2302
Mailing Address3460 Katella AveLos Alamitos, CA 90720-2334 · (562) 594-6599 · Fax (562) 598-7116
Phone(949) 923-3250
Fax(855) 812-5865
Organization SubpartNo
Authorized OfficialJacquelyn Lee Vander WallMd · (562) 594-6599
Enumeration DateOctober 16, 2006
Last NPPES UpdateApril 26, 2016
✔ NPI 1386724375 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · G065045
Definition
An 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.
11 TECHNOLOGY DR, Irvine, CA 92618
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Other Names 1

Doing Business AsOptumcare Medical Group

Other Identifiers 5

Medicaid00G65045GCA
OtherCB252872CA · Medicare
Medicare ID-Type UnspecifiedW18164CA · Group Medicare Number
Medicare UPINE80521CA
Medicare ID-Type UnspecifiedWG65045GCA · Individual Medicare Numbe

Group Practice 1

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

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 05D0722506

Centers For Family Medicine Dba Optum · Los Alamitos, CA
Active · expires Jun 9, 2028
CLIA Number05D0722506
Laboratory TypePhysician Office
Certificate Effective DateJune 10, 2026
Certificate Expiration DateJune 9, 2028
Laboratory DirectorDeborah Pauer MD
Laboratory Phone(562) 594-6599
Laboratory LocationCenters For Family Medicine Dba Optum3460 Katella Avenue, Los Alamitos, CA 90720
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

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.

DR. MARIA TERESA CORPIN AGNER MD
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (855) 206-6764
DR. SHAHNOOS MAHDAVI M.D.
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (855) 206-6764
DR. JUSTIN D HARRIS M.D.
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (949) 923-3200
DR. SUBRATO GHOSH MD
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (855) 206-6764
DR. PARAG SHARMA M.D.
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (855) 206-6764
DR. HAI XUAN LE M.D.
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (949) 923-3200
DR. MOLOOD HADI DO
Internal Medicine
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (949) 923-3200
DR. ALI AHOUI MD
Hospitalist
11 TECHNOLOGY DR
IRVINE, CA 92618
Orange County (855) 206-6764

Frequently 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 Jacquelyn Vander Wall MD. Inc's NPI number?

The NPI number for Jacquelyn Vander Wall MD. Inc is 1386724375. It was assigned to this organization in the NPPES registry on October 16, 2006. The provider is doing business as Optumcare Medical Group.

Where is Jacquelyn Vander Wall MD. Inc located?

Jacquelyn Vander Wall MD. Inc is located at 11 Technology Dr, Irvine, CA 92618. The listed phone number is (949) 923-3250.

What is Jacquelyn Vander Wall MD. Inc's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Jacquelyn Vander Wall MD. Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0722506) is associated with this NPI, valid through June 9, 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 Jacquelyn Vander Wall MD. Inc was last updated on April 26, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.