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 Name | JACQUELYN VANDER WALL MD. INC |
| Location Address | 11 TECHNOLOGY DR IRVINE, CA 92618 |
| Location Phone | (949) 923-3250 |
| Mailing Address | 3460 KATELLA AVE LOS ALAMITOS, CA 90720 |
| NPI Entity Type | Organization |
| Is Sole Proprietor? | N/A |
| Is Organization Subpart? | No |
| Other Organization Name | OPTUMCARE MEDICAL GROUP |
| Other Name Type | Doing Business As (3) |
| Enumeration Date | 10-16-2006 |
| Last Update Date | 04-26-2016 |
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 Code | 174400000X |
| Classification | Specialist |
| Type | Other Service Providers |
| License No. | G065045 |
| License State | CA |
| Taxonomy Description | 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. |
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
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
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 Number | 05D0579395 |
| Facility Type | PHYSICIAN OFFICE |
| Certificate Type | Certificate 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 |
|---|---|---|---|
| 00G65045G | MEDICAID (05) | CA | |
| CB252872 | OTHER (01) | CA | MEDICARE |
| W18164 | MEDICARE ID-TYPE UNSPECIFIED (04) | CA | GROUP MEDICARE NUMBER |
| E80521 | MEDICARE UPIN (02) | CA | |
| WG65045G | MEDICARE ID-TYPE UNSPECIFIED (04) | CA | INDIVIDUAL 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. | |||||||||
| 1 | 3 | 8 | 6 | 7 | 2 | 4 | 3 | 7 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 16 | 6 | 14 | 2 | 8 | 3 | 14 | |
| 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 = 5 | 5 | ||||||||
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 | Pharmacist | 11 TECHNOLOGY DR IRVINE, CA 92618 (808) 203-4537 |
| 1821155326 | DR. TENGIS RIZNIS MD Individual | Family Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (949) 923-3200 |
| 1699950097 | NORRIS VIVATRAT M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (949) 923-3200 |
| 1932330453 | KATE DO-QUYEN LE Individual | Pharmacist | 11 TECHNOLOGY DR IRVINE, CA 92618 (949) 453-4171 |
| 1447254792 | DR. JUAN MARIA CABRERA M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1417954306 | DR. RONALD LEE MD Individual | Family Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1083607055 | DR. SUBRATO GHOSH MD Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1508847971 | DR. MELANIE R WOLF DO Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1841262763 | DR. FRANCISCO S PEREZ M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1083689129 | DR. PARAG SHARMA M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1083675821 | FARIDEH FARID BAHRAMI RNP Individual | Nurse Practitioner | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1184688475 | DR. KAMBIZ V KARIMI M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1164477576 | SALLY BETH KEENER NP Individual | Nurse Practitioner | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1912944166 | DR. SARA SOOHEE KIM M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1922049188 | DR. OWRANG DASTMALCHI D.O. Individual | Hospitalist | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1386688471 | DR. THUY ADRIANNE NGUYEN D.O. Individual | Family Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1770528515 | DR. VIET HOANG NGUYEN D.O. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1407892490 | DR. SIAMAK N NABILI M.D. Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1780690131 | DR. SHAHAB ZAHED MD Individual | Internal Medicine | 11 TECHNOLOGY DR IRVINE, CA 92618 (855) 206-6764 |
| 1689762197 | DR. BENHOOR KHALPARI M.D. Individual | Internal Medicine | 11 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]
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