JACQUELYN LEE VANDER WALL M.D.
NPI 1699807792
Internal Medicine - Geriatric Medicine in Los Alamitos, CA

Q: What is Jacquelyn Vander Wall's NPI number?

The NPI number for Jacquelyn Vander Wall is 1699807792. It was assigned to this individual provider in the NPPES registry on March 12, 2007.

Q: What is Jacquelyn Vander Wall's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Geriatric Medicine, with taxonomy code 207RG0300X.

Active since March 12, 2007PECOS EnrolledAccepts Medicare Assignment

3460 KATELLA AVE, LOS ALAMITOS, CA 90720(702) 579-3203 Get Directions Write a Review

NPPES record last updated: November 30, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 30, 2025, Sep 13, 2017 (2 updates tracked since 2017).

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About Jacquelyn Lee Vander Wall M.d. NPPES

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

JACQUELYN LEE VANDER WALL M.D. (NPI 1699807792) is an individual geriatric medicine provider in Los Alamitos, California, licensed in California (G065045) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS, maintains a secondary practice location in Irvine, and is a graduate of University Of California, San Francisco School Of Medicine (1987).

NPPES Registry Identity

NPI1699807792

Entity TypeIndividualFemale

Primary Taxonomy207RG0300X

Provider Legal NameJACQUELYN LEE VANDER WALLCredential: M.D.

Location Address3460 KATELLA AVELos Alamitos, CA 90720-2334

Mailing AddressPo Box 35380Las Vegas, NV 89133-5380 · (702) 579-3203

Phone(702) 579-3203

Sole ProprietorNo

Medical School CMSUniversity Of California, San Francisco School Of MedicineGraduated 1987

Enumeration DateMarch 12, 2007

Last NPPES UpdateNovember 30, 20252 updates tracked since enumeration

NPPES CertifiedNovember 30, 2025

✔ NPI 1699807792 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207RG0300X

License✔ Licensed in CA · G065045

Definition

An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.

3460 KATELLA AVE, Los Alamitos, CA 90720

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Secondary Practice Location 1

Location 111 Technology DrIrvine, CA 92618-2302 · Phone (949) 923-3250 · Fax (855) 812-5865

Other Identifiers 1

Medicaid00G65045GCA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacquelyn Lee Vander Wall 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 ID6002871506

PECOS Enrollment IDI20041123001272

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.

Medicare Billing Reassignments

Medicare enrollment records show Jacquelyn Vander Wall reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Centers For Family Medicine Gp

Same address

Family Medicine

3460 KATELLA AVE
Los Alamitos, CA 90720

Reassigned Medicare billing, California enrollment
228 clinicians in this Medicare group

NPI 1467598243 (562) 594-6599

Healthcare Partners Affiliates Medical Group

15 mi

Addiction Medicine

14591 NEWPORT AVE
Tustin, CA 92780

Reassigned Medicare billing, California enrollment
2,052 clinicians in this Medicare group

NPI 1891981502 (714) 442-4864

Signify Health Medical Associates Of California, PC

367 mi

General Practice

505 MONTGOMERY ST, FL 10 & 11
San Francisco, CA 94111

Reassigned Medicare billing, California enrollment
407 clinicians in this Medicare group

NPI 1124685169 (972) 715-3800

Signify Health Medical Associates, PLLC

1,227 mi

General Practice

4055 VALLEY VIEW LN STE 700
Dallas, TX 75244

Reassigned Medicare billing, Oregon enrollment
182 clinicians in this Medicare group

NPI 1750845863 (972) 715-3800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90720 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

$187.60 typical visit price

range $62.96 – $187.60

Typical copayment $46.90 (range $15.74 – $46.90)

Most-billed visit code 99205

Established Patient

$109.96 typical visit price

range $20.84 – $153.61

Typical copayment $27.49 (range $5.21 – $38.40)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

49%306 patients3/55-star benchmark: 85%

Diabetes: Medical Attention for Nephropathy

The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period

84%67 patients4/55-star benchmark: 99%

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

92%2,006 patients4/55-star benchmark: 100%

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

95%1,402 patients4/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period

65%718 patients3/55-star benchmark: 99%

Health Information Exchange

The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…

56%229 patients3/55-star benchmark: 98%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

99%449 patients4/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

74%456 patients4/55-star benchmark: 99%

Pneumococcal Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

85%718 patients4/55-star benchmark: 90%

Preventive Care and Screening: Influenza Immunization

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

69%586 patients4/55-star benchmark: 88%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Patients screenedForUse: 96% · 724 patients

Patients tobacco: 95% · 724 patients

95%724 patients4/55-star benchmark: 98%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

95%456 patients4/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

15%456 patients2/55-star benchmark: 59%

Use of High-Risk Medications in the Elderly

Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.

Lower rates are better for this measure.

Patients 2+: 4% · 1,436 patients

14%1,436 patients2/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 2

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

5 suppliers12 claims26 services$4.32 avg. paid by Medicare

Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram J7608

DME-Drugs Administered Through DME · category DG000N

1 supplier12 claims118 services$4.86 avg. paid by Medicare

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

Other Providers at the Same Location NPPES 17

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

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