Jessica Wall Divine, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

145258 Issued in CA

Practice address

1080 Emeline Ave
Santa Cruz, CA 95060-1966

Phone

(831) 454-4100

Fax

(831) 454-4488

NPI assigned

Jul 9, 2013

Last updated

Feb 19, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jessica Lauren Wall Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of Santa CruzGroup PAC ID 7618872912, 65 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Dominican Hospital Hospital, Santa Cruz, CA, CCN 050242

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• County of Santa Cruz

  • Clinic/Center
  • Santa Cruz, CA
  • NPI 1659315430
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  dba Sutter Gould Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986

  Family Medicine

  Medicare reassignment NPD
• County of Santa Cruz

  • Federally Qualified Health Center (FQHC)
  • Santa Cruz, CA
  • NPI 1578680310
  NPD
• County of Santa Cruz

  dba Watsonville Health Center

  • Federally Qualified Health Center (FQHC)
  • Watsonville, CA
  • NPI 1770709149
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD

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

• Dignity Health

  dba Dominican Hospital

  • General Acute Care Hospital
  • Santa Cruz, CA
  • NPI 1427181007
  Care Compare affiliation

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1184065930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-454-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-454-4100",
            "fax_number": "831-454-4488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2575 E Bidwell St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Folsom",
            "state": "CA",
            "postal_code": "956306447",
            "country_code": "US",
            "telephone_number": "916-817-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "JESSICA",
        "middle_name": "WALL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-09",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116026459",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "145258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "WALL",
            "middle_name": "LAUREN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Courtney Jane Dimpel
• Caitlin Nicole Dios, ATC
• Casey Diraimondo, BA
• Tina Hope Distad, CMT
• Divine Senior Care Inc.
• Lauren Camile Dixon, CASE MANAGER
• Jasmine Dizon
• Daniel David Dlubac
• Steven DO
• Tram Anh Thuy DO

• Family Medicine Physician in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.