NPIMap

Individual provider Active NPI

Jean Karyn Waltuch, MD

  • Internal Medicine Physician
  • Menlo Park, CA
National Provider Identifier
1093770919
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A60642 Issued in CA
Practice address
1300 Crane St
Menlo Park, CA 94025-4260
Phone
(650) 498-6500
NPI assigned
Apr 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A60642 CA Primary

Addresses

Primary practice location

1300 Crane St
Menlo Park, CA 94025-4260

Mailing address

1300 Crane St
Menlo Park, CA 94025-4260
Phone (650) 498-6500

Other identifiers 1

IdentifierTypeStateIssuer
MMM00087MOtherNHIC

Other names 1

  • Jeanie K Waltuch Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050401000953 CA Practitioner - Internal Medicine 3971550849 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

1300 Crane St
Menlo Park, CA 94025-4260
Phone (650) 498-6500

Hospital & facility affiliations

  • Stanford Health Care Hospital, Stanford, CA, CCN 050441
  • El Camino Health Hospital, Mountain View, CA, CCN 050308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A60642CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Feb 6, 2020 Accepting new patients
University Healthcare Alliance Internal Medicine CurrentSince Mar 29, 2005 Accepting new patients
Stanford Health Care Internal Medicine CurrentSince Feb 6, 2020 Accepting new patients
Affinity Medical Group Past Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients

Locations

50 E Hamilton Ave
Ste 280
Campbell, CA 95008
Phone (408) 227-2646

1300 Crane St
Menlo Park, CA 94025
Phone (510) 785-5000

4725 1st St
Ste 100
Pleasanton, CA 94566
Phone (925) 462-7060

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Interoperability endpoints

  • Direct secure messaging: jwaltuch32710@direct.stanfordhealthcare.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1093770919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 CRANE ST",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254260",
            "telephone_number": "650-498-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 CRANE ST",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254260",
            "telephone_number": "650-498-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTUCH",
        "first_name": "JEAN",
        "middle_name": "KARYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A60642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHIC",
            "identifier": "MMM00087M",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANIE",
            "last_name": "WALTUCH",
            "middle_name": "K",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Menlo Park, CA

Sources for this page

Verify at the official NPI Registry.