Jacquelyn Lee Vander Wall, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

G065045 Issued in CA

Practice address

3460 Katella Ave
Los Alamitos, CA 90720-2334

Phone

(702) 579-3203

NPI assigned

Mar 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

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 2

Specialty

Internal Medicine

Education

University of California, San Francisco School of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Healthcare Partners Affiliates Medical GroupGroup PAC ID 7315842002, 775 clinicians

Centers for Family Medicine GPGroup PAC ID 9931143799, 87 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uci Health-Orange Hospital, Orange, CA, CCN 050348
• Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jacquelyn.vanderwall.p33@direct.monarchhealthcare.nextgenshare.com
• Direct secure messaging: jvanderwall194878@westdirect.optum.com
• Direct secure messaging: jacquelyn.vanderwall.p7@direct.monarchhealthcare.nextgenshare.com
• Direct secure messaging: jacquelyn.vanderwall.p1@direct.monarchhealthcare.nextgenshare.com

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.

• Centers for Family Medicine GP

  • Family Medicine Physician
  • Los Alamitos, CA
  • NPI 1467598243
  Medicare reassignment Care Compare group NPD
• Healthcare Partners Affiliates Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment Care Compare group NPD
• Signify Health Medical Associates of California, PC

  • General Practice Physician
  • San Francisco, CA
  • NPI 1124685169
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  OR

  Medicare reassignment NPD
• Healthcare Partners Affiliates Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD
• GN Medical Associates, Inc.

  • Family Medicine Physician
  • Costa Mesa, CA
  • NPI 1275576522
  NPD (past)

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

• Long Beach Memorial Medical

  • General Acute Care Hospital
  • Long Beach, CA
  • NPI 1962442012
  Care Compare affiliation
• University of California Irvine

  • Urgent Care Clinic/Center
  • Irvine, CA
  • NPI 1518739309

  Hospital

  Care Compare affiliation
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  Care Compare affiliation

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764460800000",
    "number": "1699807792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 KATELLA AVE",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202334",
            "telephone_number": "702-579-3203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Technology Dr",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926182302",
            "country_code": "US",
            "telephone_number": "949-923-3250",
            "fax_number": "855-812-5865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDER WALL",
        "first_name": "JACQUELYN",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2025-11-30",
        "certification_date": "2025-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "G065045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G65045G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Rosamaria Chavez Valencia, MSW, LCSW
• Heather Valentino, LCSW
• Monique Adrianne Valle, AMFT
• Grietje Van Dyk, MD
• Robert L Vande Steeg, PHD
• Vanderburg Psychological, Inc.
• Kevin Vanlant, PH.D.
• Cindy Vann, LCSW
• Bruce Edwin Vannatta, MD
• Fatima Vargas

• Geriatric Medicine (Internal Medicine) Physician in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.