NPIMap

Individual provider Active NPI

Vijay K Wali, MD

  • Emergency Medicine Physician
  • Anaheim, CA
National Provider Identifier
1215970389
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A40187 Issued in CA
Practice address
1111 W la Palma Ave
Anaheim, CA 92801-2804
Phone
(714) 774-1450
NPI assigned
Jun 14, 2006
Last updated
May 13, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A40187 CA Primary

Addresses

Primary practice location

1111 W la Palma Ave
Anaheim, CA 92801-2804

Mailing address

PO Box 10070
Westminster, CA 92685-0070
Phone (562) 809-3543

Other identifiers 1

IdentifierTypeStateIssuer
00A401870MedicaidCA

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
I20040526001012 CA Practitioner - Emergency MedicinePractitioner - Internal Medicine 7618967829 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Jude Emergency Medical Group IncGroup PAC ID 8224923479, 20 clinicians
Gem Medical Group CorporationGroup PAC ID 3072984400, 54 clinicians

Practice addresses (Care Compare)

101 E Valencia Mesa Dr
Fullerton, CA 92835-3809
Phone (714) 871-3280

9080 Colima Rd
Whittier, CA 90605-1600
Phone (877) 346-2211

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A40187CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Emergency Medical Associates, Inc Emergency Medicine CurrentSince Apr 1, 2021 Accepting new patients
Gem Medical Group Corporation Emergency Medicine CurrentSince May 28, 2023 Accepting new patients
Gem Medical Group Corporation Emergency Medicine CurrentSince May 28, 2023 Accepting new patients
St Jude Emergency Medical Group Inc Emergency Medicine CurrentSince Mar 1, 2021 Accepting new patients
Spectrum Emergency Physicians Group Inc. Emergency Medicine CurrentSince Jan 1, 2022 Accepting new patients
Southland Emergency Medical Associates Inc Emergency Medicine CurrentSince May 20, 2017 Accepting new patients
Chase Dennis Emergency Medical Group Inc Emergency Medicine Past Accepting new patients
Pediatric Surgical Associates Inc a Medical Corporation Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
University of California Irvine Past Accepting new patients

Locations

1111 W La Palma Ave
Anaheim, CA 92801
Phone (714) 774-1450

101 E Valencia Mesa Dr
Fullerton, CA 92835
Phone (714) 446-7505

525 N Garfield Ave
Monterey Park, CA 91754
Phone (626) 573-2222

900 S Atlantic Blvd
Monterey Park, CA 91754
Phone (626) 457-7450

Dept LA 25308
Pasadena, CA 91185

1701 Santa Anita Ave
South El Monte, CA 91733
Phone (626) 350-7916

9080 Colima Rd
Whittier, CA 90605
Phone (562) 907-1565

Organizations & group practices 11

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.

Hospital & facility affiliations 3

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1215970389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10070",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926850070",
            "telephone_number": "562-809-3543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W LA PALMA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012804",
            "telephone_number": "714-774-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALI",
        "first_name": "VIJAY",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A40187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A401870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.