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JACQUELYN LEE VANDER WALL M.D. NPI 1699807792


NPI Information

NPI: 1699807792
Provider Name: JACQUELYN LEE VANDER WALL, M.D.
Classification: Internal Medicine - 207RG0300X
Entity Type: Individual

Specialization: Geriatric Medicine

Organization: CENTERS FOR FAMILY MEDICINE

PECOS Registration: Yes

Address:
11 TECHNOLOGY DR
IRVINE, CA
ZIP 92618
Phone: (949) 923-3250
Get Directions

Jacquelyn Lee Vander Wall, M.D. is a geriatric medicine internal medicine in Irvine, CA with 37 years of experience. The provider is 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. Jacquelyn Lee Vander Wall, M.D. NPI is 1699807792. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
Graduation Year:1987

The provider's business location address is:

11 TECHNOLOGY DR
IRVINE, CA
ZIP 92618-302
Phone: (949) 923-3250
Fax: (855) 812-5865

The NPI 1699807792 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
  • Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
  • Urinalysis, manual test (HCPCS:81002)
  • Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im (HCPCS:G0179)
  • Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple (HCPCS:G0180)
  • Removal of impact ear wax, one ear (HCPCS:69210)
  • Stool analysis for blood to screen for colon tumors (HCPCS:82270)

The enumeration date for this NPI number is 3/12/2007 and was last updated on 9/13/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RG0300XInternal MedicineGeriatric MedicineG065045CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1E80521MEDICARE UPINCALIFORNIA
2110235790MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
3CB252872MEDICARE PINCALIFORNIA
400G65045GMEDICAIDCALIFORNIA
5W18164MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
6WG65045GMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.